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Conjunctivitis, infective

Conjunctivitis (Infective)
Introduction
The white part of your eye and the inner surfaces of your eyelids are covered by a transparent membrane (thin layer of cells) known as the conjunctiva. If the conjunctiva becomes inflamed, you have a condition called conjunctivitis. There are three types of conjunctivitis - irritant, allergic, and infective. Each type of conjunctivitis is caused by different factors. Irritant conjunctivitis
Irritant conjunctivitis occurs when an irritant, such as chlorine, or an eyelash, gets into your eyes. This can make your eyes sore and if you rub them, it can make the soreness even worse. Avoiding the irritant and not rubbing your eyes will help. However, if your eyes are very red and painful, you should Allergic conjunctivitis
Allergic conjunctivitis occurs when your eye comes into contact with an 'allergen'. An allergen is a particular substance that makes your body's immune system react abnormally, causing irritation and inflammation in the affected body part. This health encyclopaedia topic focuses on infective conjunctivitis. Further information about allergic conjunctivitis is available as a separate leaflet. Infective conjunctivitis
Infective conjunctivitis can be caused by a virus, by bacteria or, in rare cases, by a sexually transmitted infection, such as Chlamydia, or gonorrhoea). The most common symptoms include reddening and watering of the eyes. You may also notice a sticky coating on your eyelashes, particularly when you first wake in the morning, which can make your eyes feel like they are stuck together. Infective conjunctivitis is a very common condition, and is responsible for 35% of all eye-related problems recorded in GP surgeries. It is most common in children and the elderly. Infective conjunctivitis rarely requires any medical treatment because the infection will normally heal by itself, usually within 1-2 weeks. For most people, infective conjunctivitis does not cause any complications. Those most at risk of developing complications from infective conjunctivitis are newborn babies, who are
28 days old, or younger. An infection in the eye at a very young age can cause permanent damage. If
you have infective conjunctivitis that is caused by a sexually transmitted infection (STI), such as
chlamydia, your condition may last several months, rather than weeks.
Symptoms
The symptoms of infective conjunctivitis will normally begin in one eye. However, after a few days, you will often find that the other eye becomes affected too. The symptoms of infective conjunctivitis can vary from person to person, but may include those listed below. • Reddening of the affected eye(s) - this happens as a result of the irritation and widening of
the tiny blood vessels in your conjunctiva (thin layer of skin inside your eyelids). If your eyes are very red and very painful, or if your vision is affected, or if your eyes are extremely sensitive to light (photophobia), you should seek immediate medical assistance. • Watering eyes - the conjunctiva contain thousands of cells that produce mucus, and tiny glands
that produce tears. Irritation causes the glands to become overactive, so that they water more than usual. • Sticky coating on eyelashes - you are more likely to notice this when you first wake in the
morning. Your eyelids may feel like they are stuck together because the pus that is produced by the infection forms into sticky clumps on your lashes. • Slight soreness.
Swollen eyelids.
Enlarged lymph node in front of the ear - a lymph node is part of the body's immune
system, and helps protect the body from bacteria and infection. You might feel an enlarged lymph node as a raised bump, underneath the skin. If you are suffering from infective conjunctivitis, you may also have the symptoms of an upper respiratory tract infection. An upper respiratory tract infection is one that affects your throat and • coughing,fever, headache, and aching limbs. Infective conjunctivitis occurs when the conjunctiva (the thin layer of cells covering the white of your eye and the inner surface of your eyelids) becomes inflamed as a result of an infection. There are a variety of factors which can cause an infection to develop in your eye. The three most common causes • bacteria, viruses, and sexually transmitted infection (STI). There are no particular signs or symptoms that will allow your GP to distinguish between a bacterial infection and a viral infection. Both types of conjunctivitis will normally heal by themselves. If your conjunctivitis is caused by a sexually transmitted infection (STI), such as chalmydia, it will usually result in your conjunctivitis lasting for several months, rather than weeks. If your condition is persistent, you will have an eye swab to determine the cause of the infection (see 'diagnosis' section). If your infective conjunctivitis is caused by an STI, you will have to undergo screening and treatment for the infection. Newborn babies can develop conjunctivitis if the mother has Chlamydia because the infection is often passed to the baby during birth. Spreading the infection
You are more likely to develop infective conjunctivitis if you have been in close contact with someone who is already infected. It is therefore very important that you make sure that you wash your hands thoroughly after coming into contact with someone who has the condition.
Diagnosis
In most cases of infective conjunctivitis, your GP will be able to diagnose the condition from your symptoms and by examination. Red, swollen eyes, which are covered in a sticky discharge, are very common features of infective conjunctivitis. Other conditions
Most cases of infective conjunctivitis will heal without treatment within one to two weeks. If you are still suffering from the symptoms of conjunctivitis after two weeks, you will need to see your GP again, so that they can reassess your diagnosis and treatment. Your GP will make sure that you are not suffering from a different form of the condition, such as allergic, or irritant conjunctivitis, as this will affect the type of treatment you are prescribed. Your GP will also check to see that you are not suffering from any other eye condition, such as blepharitis which is a condition that causes your eyelids to become inflamed and swollen. If you experience any of the following symptoms, you should see your GP immediately: • moderate to severe pain in your eyes, It is very important for you to seek medical assistance if you experience these symptoms because it may be an indication that there is a more serious condition that is causing them. This is why it is important for your GP to rule out any other conditions which, if undiagnosed, may possibly cause serious complications. Some conditions which may cause reddened eyes are outlined below. • Acute glaucoma - this is a rare form of glaucoma which causes a build up of pressure in the
eye. Symptoms of pain, and loss of vision, can develop very rapidly. Left untreated, acute glaucoma can result in a permanent loss of vision. • Keratitis - this is when your cornea (the clear layer at the front of your eye that allows light to
travel through your eye) becomes inflamed, and sometimes ulcerated. In severe cases, this can cause scarring of the cornea, which can lead to a permanent loss of vision. • Iritis - this condition causes your iris (the coloured part of your eye, behind the cornea) to
become inflamed. If you have iritis, and it is not treated, it can cause the iris to stick to the front surface of the lens, which prevents fluid draining from the pupil. This can cause permanent damage to the eye. Swab test
If your GP is unsure about the diagnosis, or needs to determine the cause of your infection, they may have to take a swab from your infected eye. This will be tested in a laboratory to find out the cause of your condition. Your GP can then provide you with the most appropriate treatment. While your GP is awaiting the results of your swabs, you may be prescribed a short course of antibiotics to help keep your symptoms under control. When your GP finds out the results of the swab, you will then be prescribed the most suitable form of treatment for the cause of your condition. Newborn babies
If your baby is 28 days old, or younger, and displays symptoms of infective conjunctivitis, it is important to contact your GP straight away. Many babies may have what is known as a 'sticky eye'. This usually occurs when the tear (lachrymal) duct cannot drain properly. If it cannot drain, it produces a discharge of pus, which can look similar to infective conjunctivitis. However, this condition is not serious, and does If your baby also has redness in their eye, it may be a sign that the eye is infected. Your GP will examine your baby closely to see if this is the case. Any newborn babies with infective conjunctivitis must be referred to an eye specialist (ophthalmologist) straight away, so that their condition can be managed and treated to prevent any damage occurring to the eye. Infective conjunctivitis in newborn babies (neonatal conjunctivitis) can, in rare cases, cause serious complications (see 'complications' section). However, with prompt treatment, most babies will make a full recovery.
Treatment
The majority of cases of infective conjunctivitis do not require any medical treatment. As most infections will heal without treatment within one to two weeks, your GP may not initially prescribe any particular Self-care;-
• If you have infective conjunctivitis, there are a number of ways that you can treat your condition at home. If you follow the guidelines which are outlined below, they should help to speed your recovery. • Remove contact lenses - if you wear contact lenses, you should take them out until all the signs and symptoms of the infection have been resolved. You should also avoid using contact lenses until 24 hours after you have finished a course of treatment, such as antibiotics. • Lubricant eye drops - these can be purchased over-the-counter (OTC), or they may be prescribed for you. They may help to ease any soreness and stickiness in your eyes. • Gently clean away sticky substances - when you wake in the morning, you may notice that your eyes have secreted a sticky substance that sticks to your eyelashes. You can gently clean this away from your eyelids and eyelashes using cotton wool soaked in water. • Wash your hands regularly - this is particularly important after you have touched your infected eye to prevent spreading infection to others. • In most cases, antibiotics will make little difference to your recovery from infective conjunctivitis. Therefore, you may be advised to delay using the medicine for seven days in order to see if the condition can resolve itself first. • About 10% of people who have their infective conjunctivitis treated with antibiotics experience adverse side effects. The risk of any complications from untreated infective conjunctivitis is very low, and so treatment with antibiotics is rarely necessary. • If your infective conjunctivitis is particularly severe, and has lasted for more than two weeks, you may require antibiotic treatment. Some schools, or playgroups, insist that a child is treated
with antibiotics before they can return (although this is rarely necessary - see 'prevention'
section). However, if this is the case, your GP may agree to prescribe antibiotics.
Which antibiotics may be prescribed?
If your GP decides that antibiotics are necessary for your treatment, there are two main types of antibiotics which may be prescribed. These are outlined below. • Chloramphenicol - this is the first choice of antibiotic to be used for severe infective conjunctivitis. It is usually in the form of an eye drop, which is taken every two hours, for two days, and then every four hours for five days (but only while you are awake). If eye drops are not suitable, you may be prescribed this antibiotic in ointment form instead. • Fusidic acid - this is usually prescribed if Chloramphenicol is not suitable for you. Fusidic acid is also more suitable for pregnant women. It comes in the form of eye drops, which normally have to be used twice a day, for seven days. • If you have been prescribed eye drops, your vision may become blurred shortly after using them. You should not to drive, or operate machinery straight after using eye drops, and, before doing so, you should always make sure that your vision is clear. • If you still have symptoms after two weeks, it is very important that you go back to your GP, so that your condition can be reassessed, and your treatment reviewed. • You must also contact your GP immediately if you experience any of the following symptoms: • moderate to severe eye pain, photophobia (sensitivity to light), loss of vision, or intense redness It may be a sign that your symptoms have a more serious cause (see 'diagnosis' and 'complications'
sections).
Complications
If you have infective conjunctivitis which has been caused by bacteria or a virus, there will rarely be any Most complications are caused when the condition is the result of a sexually transmitted infection (STI). If your infection has been caused by Chlamydia, then it may cause your conjunctivitis to last for several months, rather than weeks. Neonatal conjunctivitis
Those most at risk of developing complications from infective conjunctivitis are newborn babies (neonates) who are 28 days old, or younger. Infective conjunctivitis can lead to a severe and rapidly progressive eye infection that, in severe cases, may affect their vision. Babies are most susceptible to Chlamydia infections. 10-20% of newborn babies with infective conjunctivitis caused by Chlamydia go on to develop pneumonia, a potentially life-threatening illness which affects the lungs. However, any type of bacterial conjunctivitis can cause complications for a young baby. In rare cases, infective conjunctivitis can lead to the following conditions: • Meningitis - an infection of the layer of cells (meninges) which cover the brain and spinal cord.
This is potentially a very serious illness which, in severe cases, can be fatal. • Cellulitis - an infection of the deep layer of skin and tissue which causes the skin on the surface
to become sore and inflamed. However, it is usually easily treated using antibiotics. • Septicaemia - is more commonly known as blood poisoning. The condition occurs when bacteria
gets into the bloodstream and starts to attack the body's tissues. These complications are rare, and most babies will make a full recovery from infective conjunctivitis. If
your newborn child is found to have the condition, they will be referred immediately for specialist
assessment and treatment, and their condition will be closely monitored to minimise the risk of
complications arising.
Prevention
The best way to stop infective conjunctivitis spreading is to make sure that you thoroughly wash your hands after touching, or treating, your infected eyes. If you do not have the infection, but someone close to you does, you should make sure that you wash your hands every time you come into contact with them. You should also avoid sharing towels, pillows, and flannels in order to prevent the infection from spreading. Should I keep my child home from school?
Unless there is an outbreak of infective conjunctivitis at your child's school, you will not have to keep your child at home. The Health Protection Agency (HPA) states that it is not advisable to exclude children from schools, or playgroups, if they have a mild, infectious illness, such as a cold or infective conjunctivitis. Conjunctivitis (Allergic)
Introduction
The white part of your eye and the inner surfaces of your eyelids are covered by a transparent membrane (thin layer of cells) known as the conjunctiva. If the conjunctiva becomes inflamed, you have a condition called conjunctivitis. There are three types of conjunctivitis - irritant, allergic, and infective. Each type of conjunctivitis is caused by different factors. Irritant conjunctivitis
Irritant conjunctivitis occurs when an irritant, such as chlorine, or an eyelash, gets into your eyes. This can make your eyes sore and if you rub them, it can make the soreness even worse. Avoiding the irritant and not rubbing your eyes will help. However, if your eyes are very red and painful, you should Infective conjunctivitis
Infective conjunctivitis is caused by a virus, or bacteria. Allergic conjunctivitis
Allergic conjunctivitis is a common condition and is responsible for 15% of all eye-related problems recorded in GP surgeries. It occurs when your eye comes into contact with an 'allergen'. An allergen is a particular substance that makes your body's immune system react abnormally, causing irritation and inflammation in the affected body part. This is known as an allergic reaction. Common examples of allergens include pollen, dust mites and animal fur. There are four main types of allergic conjunctivitis. The two most common types are outlined below. • Seasonal allergic conjunctivitis - is the most common type of conjunctivitis, accounting for
half of all allergic conjunctivitis cases. Symptoms recur at the same time each year and are most commonly triggered by pollen. • Perennial allergic conjunctivitis - symptoms occur all year round, and are usually present
when you wake in the morning. The symptoms can be caused by a variety of allergens, such dust mites, or animal fur. • The other two types of allergic conjunctivitis are less common. They are outlined below. • Contact dermatoconjunctivitis - conjunctivitis with allergic dermatitis of the eyelids. Together
with the usual symptoms of conjunctivitis, this condition causes the skin on your eyelids to become red, cracked, sore and inflamed (dermatitis). Eye drops are the most common cause of contact dermatoconjunctivitis. • Giant papillary conjunctivitis - most commonly occurs in people using soft contact lenses. It
may also develop following eye surgery. Your symptoms tend to progress slowly. Symptoms
The symptoms of allergic conjunctivitis usually affect both eyes. Your symptoms may appear very suddenly, often immediately after coming into contact with an allergen In other cases, your symptoms will develop 24-48 hours after you have come into contact with the allergen. The symptoms of allergic conjunctivitis may include those listed below. • Reddening of the eyes - is the most common symptom of allergic conjunctivitis. It occurs as a
result of the irritation and widening of the tiny blood vessels in your conjunctiva (thin layer of skin inside your eyelids). If your eyes are very red and they are very painful, or if your vision is affected, or your eyes are extremely sensitive to light (photophobia), you should seek immediate medical assistance • Itchy eyes.
Watering eyes - the conjunctiva contain thousands of cells that produce mucus, and tiny glands
that produce tears. Irritation causes the glands to become overactive, so that they water more than usual. • Swollen eyelids.
Soreness and a slight burning sensation - your whole eye area may feel sore and tender
from the inflammation, and you may feel a slight burning sensation in your eyes in general. If you have seasonal allergic conjunctivitis, your symptoms may appear at certain times of the year - for example, in the spring, or summer. The symptoms of perennial allergic conjunctivitis can occur all year round, and may be worse at certain times of the day, such as first thing in the morning. Dry, red, and cracked skin on your eyelids that is sore and painful, may indicate that you have contact
dermatoconjunctivitis. The symptoms of both contact dermatoconjunctivitis, and giant papillary
conjunctivitis, may appear at any time.
Causes
Allergic conjunctivitis is most commonly caused when your eyes come into contact with an allergen. An allergen is a particular substance that causes your body's immune system to react abnormally, causing pain, soreness and inflammation in the conjunctiva. This is known as an allergic reaction. There are a variety of allergens that can cause allergic conjunctivitis which include: • pollen (hay fever), dust mites, make up, animal fur, and eye drops. The most common allergen to cause allergic conjunctivitis is pollen, which is often accompanied by sneezing, and a blocked, or runny, nose. This is called seasonal allergic conjunctivitis. When it occurs with allergic rhinitis, it is commonly known as hay fever. Seasonal allergic conjunctivitis is more common in the spring and summer months when grass, trees, and flowers are in pollen. Contact lenses and eye drops
Contact dermatoconjunctivtis and giant papillary conjunctivitis are rare conditions that are often associated with the use of contact lenses and eye drops. • Contact dermatoconjunctivtis - is always associated with inflammation of the skin around the
eye, and usually occurs in those using eye drops. • Giant papillary conjunctivitis - usually causes discomfort of your eyes when you put your
contact lenses in and, as the condition develops, your lenses will feel more and more uncomfortable, and your eyes may become redder. It can also occasionally occur if you use hard contact lenses and following eye surgery. Diagnosis
There is no procedure, or test, to confirm allergic conjunctivitis. Your GP will usually be able to make a diagnosis by assessing your symptoms. Itching eyes is the most common symptom. You GP will also ask about any other symptoms you may be experiencing. For example, if your allergic conjunctivitis is caused by pollen you may also be experiencing sneezing and congestion. Other conditions
Allergic conjunctivitis is one of several conditions which can cause your eyes to appear reddened. It is very important that your GP rules out any other conditions which may be causing your eyes to appear Referral
If you have severe symptoms of conjunctivitis, or your symptoms are getting worse, your GP may refer you to an eye specialist called an ophthalmologist. If you develop giant papillary conjunctivitis as a result of recent eye surgery, you will be immediately referred to an ophthalmologist. This is to ensure that your eyes can be carefully monitored, and the best, most effective treatment given. If your GP suspects you have dermatoconjunctivitis, you may also be referred to an ophthalmologist so that the diagnosis can be confirmed.
Treatment
Antihistamines
If your allergic conjunctivitis requires rapid relief, your GP is most likely to prescribe a medicine known as an antihistamine. This medicine may have to be taken orally, or you may have to apply it directly to Oral antihistamines that are commonly prescribed include cetirizine, fexofenadine and loratadine. You will usually only have to take an oral antihistamine once a day. Commonly prescribed eye drops include azelastine, emedastine and ketoifen. These eye drops normally have to be used two to three times a Antihistamines should help to reduce the inflammation in your eyes. They should also be able to ease related symptoms, such as sneezing and rashes. Antihistamines rarely cause side effects. However, in some cases, oral antihistamines can cause drowsiness, although this tends to occur less commonly with newer types of antihistamines than with older types. If you are taking antihistamines for the first time, it may be advisable to avoid activities such as driving, or operating machinery, until you know how the medicine affects you. Mast cell stabilizers
Mast cell stabilizers may also be prescribed to treat allergic conjunctivitis. Unlike antihistamines, they are more effective at controlling your symptoms over a longer period of time, rather that providing rapid relief and it may take several weeks before you feel the effects of this type of medicine. You may be prescribed an antihistamine to take at the same time as a mast cell stabilizer, so that your symptoms can be controlled while you are waiting for the mast cell stabilizer to take effect. Mast cell stabilizers that are commonly prescribed, include lodoxamide and nedocromil. These medications are in the form of eye drops. Corticosteroids
If your symptoms of allergic conjunctivitis are particularly severe, and the diagnosis has been confirmed, you may be prescribed a short course of an oral (by mouth) corticosteroid. However, an oral corticosteroid is very rarely needed and is not normally prescribed unless absolutely necessary.
Complications
Seasonal and perennial allergic conjunctivitis
If you have seasonal, or perennial, allergic conjunctivitis, it is very rare that you will experience any serious complications. You may find your recurring symptoms frustrating. For example, if your conjunctivitis is caused by pollen, you may find it difficult to go outside in the spring and summer months without triggering your symptoms. Allergic conjunctivitis can also affect your day-to-day life, and may make it difficult for you to concentrate at work, particularly if your eyes are severely irritated. However, although these types of conjunctivitis may impact on your daily life, they should not cause you any long-term health problems. Dermatoconjunctivitis and giant papillary conjunctivitis
As well as impacting on your daily life, dermatoconjunctivitis and giant papillary conjunctivitis may cause more serious complications. In rare cases, dermatoconjunctivitis and giant papillary conjunctivitis may cause your cornea (the clear layer at the front of your eye which allows light to travel through) to become inflamed. This condition is known as keratitis and the symptoms include: • severe eye pain, photophobia (sensitivity to light), watering eyes, blurred vision, and the sensation that there is a foreign body in your eye. Keratitis can cause ulcers to form on the cornea, which can lead to permanent scarring. If your cornea is scarred, it may permanently impair your vision. If you experience any symptoms of keratitis, make sure you contact your GP immediately.
Prevention
Self care
If you are suffering from seasonal allergic conjunctivitis, there are a number of practical things that you can do take which may help to ease your symptoms. These include: • keeping doors and windows closed when the pollen count is high, • avoiding going out at certain times of the day when the pollen count is at its highest, such as in • wearing wrap-around sunglasses when you are outside, and • fitting a pollen filter to your car. • If you wear contact lenses, and you have allergic conjunctivitis, you should: • remove your contact lenses until your symptoms resolve, • you may find that placing a cool compresses on the affected eye/s helps to ease your symptoms. Where possible, try to avoid contact with any allergens that are known to trigger your symptoms. For example, if you know that a particular type of make up causes allergic conjunctivitis, use an alternative, or stop using it altogether. Reducing your exposure to dust mites, by regularly damp dusting, can also be useful in preventing allergic conjunctivitis from developing. If you have allergic conjunctivitis, the best way to prevent your symptoms getting worse is to make sure that you treat the condition promptly. If you know which medicines best ease your symptoms, then make sure that you take them when your symptoms first begin to show. If you need to visit your GP for treatment, try to get an appointment as soon as you can.

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