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What is Pink Eye (Conjunctivitis)?

Pink eye (conjunctivitis) is an inflammation of the outermost layer of the eye (i.e. the clear membrane over the white of the eyes) and the inner surface of the eyelids. This is collectively called the conjunctiva. Pink eye is caused by an infection (either bacterial or viral, including STDs) or allergic reaction. Less commonly, pink eye can be triggered by thermal and ultraviolet burns, chemicals, foreign bodies in the eye, toxins, dry eye, vitamin deficiency, exposure to chickens that have Newcastle disease, and epithelial dysplasia.

pink eye

Types of Pink Eye (Conjunctivitis)

  • Bacterial Conjunctivitis – This is an infection most often caused by Staph or Strep bacteria from the patient’s own skin or respiratory system. Infection can also occur by transmittal from insects, other people (physical touch), or by contaminated eye makeup and facial lotions.
  • Viral Conjunctivitis – This infection is most commonly caused by contagious viruses associated with the common cold. The primary means of contracting this is by exposure to upper respiratory tract symptoms that create a aerosol of contamination (e.g. coughing, sneezing).
  • Allergic Conjunctivitis – This occurs most commonly among people who already have common seasonal allergies. At some point, they either develop or come into contact with a substance that triggers an allergic reaction in their eyes. Usually, this is triggered by a cosmetic, perfume, protein deposits on contact lenses, and drugs (less frequent). Both eyes are generally afflicted and swelling is exhibited.
  • Giant Papillary Cojunctivitis - This is thought to be an allergic reaction to a chronic foreign body in the eye. This condition occurs predominantly with people who use hard contact lenses, or have ocular prosthetics.

Pink Eye is Extremely Contagious

Pink eye is highly contagious. It can be spread as easily as the common cold, and through the same mechanisms.

  • Conjunctivitis Incubation: The incubation period is usually 24 to 72 hours for bacterial conjunctivitis, generally 5 to 12 days for viral conjunctivitis. After the incubation period, symptoms will start to appear.
  • Conjunctivitis Contagious Period: The period of communicability for bacterial conjunctivitis is any time during the course of active infection; for viral conjunctivitis it is usually the later part of the incubation period up to 14 days following onset. This essentially means that pink eye is always infectious and proper preventive care needs to be taken in order to avoid infection of others.

Symptoms & Diagnosis of Pink Eye (Conjunctivitis)

Redness, irritation, itching, and excessive watering of the eyes are common to all types of pink eye. Your doctor will typically use a slit lamp to examine your eyes and make a diagnosis.

  • Bacterial conjunctivitis is mostly due to pus-producing bacterial infections. Symptoms thus include grey or yellowish discharge (pus) from the eye that can cause the eye lids to stick together, particularly after sleeping. Grittiness and irritation of the eyes are also common, and it can be severe enough to cause a foreign body sensation. While discharge is common, it is possible to have bacterial conjunctivitis without exhibiting any discharge from the eye, and without the typical redness. Gonorrhea, a sexually transmitted disease, is a common source for bacterial conjunctivitis. Chlamydia is also another important sources, as pregnant women can pass this on to their new born. Acute infections can cause a great deal of pain as well. Similar to viral conjunctivitis, infection tends to start in one and then spreads to the other. Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma.
  • Viral conjunctivitis is mostly associated with an infection of the upper respiratory tract, common cold, or sore throat. Viral conjunctivitis may also be caused by the Herpes virus (which can also cause chickenpox), as well as corona viruses. Its main symptoms include watery discharge and varying amounts of itchiness. Infections generally start in one eye only, but can later spread easily to the other eye. Viral conjunctivitis shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis.
  • Allergic Conjunctivitis is most commonly extremely itchy and there is generally swelling of the eye lids. Allergic conjunctivitis shows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness. Chronic, undiagnosed allergic conjunctivitis can be extremely frustrating, as only the itching and irritation are felt. There is no redness or discharge from the eye and the doctor may conclude you are suffering from hypochondria. Generally, both eyes are afflicted at the same time.

How long does Pink Eye Last?

Generally, viral pink eye will resolve itself in 8 to 10 days. In bacterial cases, treatment with antibiotics can bring about a cure in 3 to 5 days.

Pink Eye in Babies

  • Opthalmia Neonatorum - a severe form of bacterial conjunctivitis that occurs in new born babies. This is an extremely serious condition that could lead to permanent occular damage unless it is treated immediately. Opthalmia neonatorum occurs when an infant is exposted to chlamydia or gonorrhea pathogens while passing through the birth canal.

Pink Eye in Children

Pink eye is a common infection among young children. The prevalent type is Viral Conjunctivitis. Kids with this type of pink eye will usually exhibit symptoms of a cold or flu, and will have watery discharge from the affected eyes. Children with pink eye are required to stay home in order to avoid infecting their classmates. Pink eye is also sometimes found in children who have concurrent ear infections.

Treatment of Pink Eye (Conjunctivitis)

Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria. However evidence suggests that this does not affect symptom severity and gains only modest reduction in duration from an average of 4.8 days (untreated controls) to 3.3 days for those given immediate antibiotics. Deferring antibiotics yields almost the same duration as those immediately starting treatment with 3.9 days duration, but with half the two-week clinic re-attendance rate.

Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with cool compresses and artificial tears. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation. Patients are often advised to avoid touching their eyes or sharing towels and washcloths. Viral conjunctivitis usually resolves within 3 weeks.

Conjunctivitis due to burns, toxic and chemical require careful wash-out with saline, especially beneath the lids, and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, intraocular damage or even loss of the eye. Fortunately such injuries are uncommon

Natural Pink Eye Remedies (Conjunctivitis)

bright eyeIn India, where the ancient medical system of Ayurveda is practiced, there are several remedies for most types of conjunctivitis; for example, goat milk is used in its purified form for certain cases and ointment made out of purified tender coconut water mixed with herbs. These are believed by Ayurvedic adherents to sooth the eyes and promote an environment in which organisms cannot thrive.

Certain supplements such as Similisan have also shown to be effective at soothing the redness, irritation, itchiness, and discharge symptoms associated with pink eye. Euphrasia Officinalis (also known as Eye Bright) is a flowering plant found in alpine or sub-alpine meadows where snow is common. Extracts of Eye Bright have been used for centuries in restoring vision and reliving symptoms associated with eye infections.

The tannin content in Eyebright accounts for its astringent properties.  It tightens membranes surrounding the eyes and prevents secretion of fluids, reducing excess phlegm and mucus in the eyes, sinuses and upper respiratory tract. It also soothes the mucous membranes, easing catarrh and relieving the discomforts of minor irritations. Eyebright is said to be effective in treating allergies, itchy and/or watery eyes and runny nose and is also thought to combat hay fever. The herb is a bitter, astringent herb that is used to relieve inflammation and infectious conditions associated with colds, coughs and sore throats.


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