Conjunctivitis

Conjunctivitis, or pinkeye, is an inflammation of the membrane covering the inside of your eyelids and the outer part of your eye. It is usually not serious, but can be highly contagious. Conjunctivitis often feels like you have something in your eye that you cannot get out.

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Signs and Symptoms

Conjunctivitis causes the following symptoms in one or both eyes:

• Redness and tearing
• Itching
• Swollen eyelid
• Discharge (watery or thick)
• Crust that forms overnight
• Sensitivity to light
• Gritty feeling

What Causes It?

Conjunctivitis is most often the result of viruses, such as those that cause the common cold. Other causes can be bacterial infections, allergies, chemicals, irritation from contact lenses, or eye injury. Viral and bacterial conjunctivitis are very contagious. Some studies suggest that sun exposure makes the disease more severe.

What to Expect at Your Doctor's Office

If you have conjunctivitis in both eyes, with itching and a clear discharge, allergies are likely the cause. Viral or bacterial conjunctivitis usually begins in one eye and then spreads to the other. Swollen glands and a watery or mucousy discharge usually indicate a virus. A thick, crusty discharge may be a sign of a bacterial infection.

Your doctor may diagnose conjunctivitis from looking at your eye and asking you about your symptoms. Your doctor may also use a slit lamp for closer examination, or gently swab a stain across the surface of your eye.

Treatment Options

Conjunctivitis is usually not serious and will often go away by itself. You should still, however, see your doctor. If left untreated, chronic conjunctivitis can cause permanent eye damage.

Treatment varies depending on what is causing the inflammation. Bacterial conjunctivitis is generally treated with antibiotic eye drops or ointment. Viral conjunctivitis does not respond to antibiotics, but antihistamines and anti-inflammatory medications may help relieve symptoms. Warm or cool compresses may help reduce itching and swelling. Artificial tears may also help flush irritants out of the eye.

Drug Therapies

• Viral conjunctivitis. Usually, your doctor will let the virus run its course. Your doctor may prescribe antiviral eye drops, such as acyclovir (Zovirax) or trifluridine (Viroptic) or artificial tears. Treatment is supportive and may include ocular decongestants and artificial tears. Cold compresses applied 3 times daily for 1 to 3 weeks may relieve discomfort.
• Allergic conjunctivitis. Your doctor may recommend allergy shots, administered over several months, to reduce your sensitivity to the allergen. Antihistamine eye drops, such as over-the-counter antazoline phosphate (Vasocon-A) or prescription olopatadine ophthalmic (Patanol) may reduce swelling or itching. An oral antihistamine can help relieve itching. A cool compress may help relieve symptoms, too.
• Bacterial conjunctivitis. Your doctor will prescribe antibiotic eye drops, such as sodium sulfacetamide (Cetamide, Bleph-10), or azithromycin, or ointment such as erythomycin (E-Mycin), bacitracin, or neomycin.

Complementary and Alternative Therapies

Alternative therapies can help relieve symptoms. But you must make sure that any solution or compress you put on your eye is sterile. Remember, too, that you can spread conjunctivitis from one eye to another. So do not touch your other eye while treating the affected eye. If you have a mild case of conjunctivitis, start with compresses. Use warm compresses for infective conjunctivitis and cold compresses for allergic or irritative conjunctivitis. For a moderate case, use a compress and an eyewash that comes pre-mixed in a sterilized package or from a competent herbal practitioner.

Nutrition and Supplements

Use the following supplements, taken by mouth for up to one week, to strengthen your immune system and help you heal faster, only under your doctor's supervision. Consult a pediatrician for children's dosages.

• Vitamin C
• Zinc

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider trained in botanical medicine. Compresses and eye washes are external treatments.

A trained herbal practitioner may prescribe an herbal eyewash. The following are some examples of the herbs used in these treatments. DO NOT attempt to use treatments on your own. You should use these treatment only under the supervision of a trained practitioner.

• Eyebright (Euphrasia officinalis). Helps fight infection and dry up excess fluid.
• Chamomile (Matricaria recutita). Helps fight infection.
• Fennel seed (Foeniculum vulgare). Helps fight infection.
• Marigold (Calendula officinalis). Soothes irritation.
• Plantain (Plantago lanceolata, P. major). Astringent and soothing. The fresh leaves are the most effective plant part.

Other herbal treatments may include:

• Ginkgo biloba extract with hyaluronic acid. In one study, using an eyewash made of this solution for 1 month caused a significant decrease in symptoms of conjunctivitis compared to hyaluronic acid alone.
• Premade herbal eyewashes are available in many health food stores. Many of them contain diluted solutions of goldenseal (Hydrastis Canadensis), which in undiluted forms can be extremely irritating to the eye. Follow manufacturer's directions carefully.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of conjunctivitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Euphrasia. For conjunctivitis with watery tears that burn the face and may become a thick discharge. Despite the production of watery tears, the individual may complain of a dry, gritty sensation in the eyes.
• Argentum nitricum. For red, swollen eyes with pus-like discharge and splintering pains.
• Pulsatilla. For conjunctivitis with yellow green discharge and itchy eyes that may accompany or immediately follow a cold. The eyelids tend to stick together, and symptoms generally improve with cold compresses. This remedy is most appropriate for individuals who tend to be irritable and have mood swings.
• Belladonna. For the first stages of conjunctivitis, including the sudden onset of burning, bloodshot eyes, swollen eyelids, and hypersensitivity to light. The eyes are generally hot and throbbing to the touch.
• Sulphur. For burning, pain, and redness of the eyes accompanied by a yellow discharge with foul odor. The eyes are often crusted together, and the individual is usually very hot and thirsty.
• Apis mellifica. For red, burning, swollen eyes that feel better with cold applications.

Following Up

Viral and bacterial conjunctivitis are both very contagious. Family members should use separate towels. Wash your hands often. Keep children home from school and day care.

Be sure to follow your doctor's advice about using any medications, especially if you have been given antibiotics or corticosteroids. If you wear contact lenses, keep them clean to avoid further irritation and future infections. DO NOT wear them until your eyes have healed.

People with allergic conjunctivitis sometimes develop a severe form with a stringy discharge, swollen eyelids, scaly skin, and significant discomfort. This needs aggressive treatment to prevent scarring of the cornea.

Special Considerations

In most U.S. hospitals, a medication such as silver nitrate is routinely administered to the eyes of newborns to prevent conjunctivitis from developing from bacteria in the birth canal.

Supporting Research

Ambroziak AM, Szaflik JP, Hapunik A. Evaluation of effectiveness and tolerance of treatment with azithromycin 1.5% eye drops in bacterial conjunctivitis. Klin Oczna. 2009;111(1-3):46-9.

Azari AA, Barney NP. Conjunctivitis: a systemic review of diagnosis and treatment. JAMA. 2013;310(16):1721-9.

Calderon MA, Penagos M, Sheikh A, et al. Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis. [Review]. Clin Exp Allergy. 2011;41(9):1263-72.

Cronau H, Kankanala R, Mauger T. Diagnosis and Management of Red Eye in Primary Care. American Family Physician. 2010;81(2).

Dadaci Z, Borazan M, Kiyici A, et al. Plasma vitamin D and serum total immunoglobulin E levels in patients with seasonal allergic conjunctivitis. Acta Ophthalmol. 2014;92(6):e443-6.

del Cuvillo A, Sastre J, Montoro J, et al. Allergic conjunctivitis and H1 antihistamines. J investig Allergol Clin Immunol. 2009;19 Suppl 1:11-8.

Engel JM, Molinari A, Ostfeld B, et al. Actinic conjunctivitis in children: Clinical features, relation to sun exposure, and proposed staging and treatment. J AAPOS. 2009;13(2):161-5.

Ferri F. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Kapoor S, Bielory L. Allergic rhinoconjunctivitis: complementary treatments for the 21st century. [Review]. Curr Allergy Asthma Rep. 2009;9(2):121-7.

Josephson L. A Homeopathic Handbook of Natural Remedies. New York, NY: Random House Digital; 2002:207-10.

La Rosa M, Lionetti E, Reibaldi M, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013;39(1824-7288):18.

Lyra AF, Bastos LC, Lima RC, et al. Aritificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis. Arq Bras Oftalmol. 2014;77(2):99-102.

Messmer EM. Bacterial conjunctivitis--diagnosis and therapy update. Klin Monbl Augenheilkd. 2012;229(5):529-33.

Nelson HS, Nolte H, Creticos P, et al. Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults. J Allergy Clin Immunol. 2011;127(1):72-80, 80.e1-2.

Russo V, Stella A, Appezzati L, et al. Clinical efficacy of a Ginkgo biloba extract in the topical treatment of allergic conjunctivitis. Eur J Ophthalmol. 2009;19(3):331-6.

Stoss M, Michels C, Peter E, et al. Prospective cohort trial of Euphrasia single-dose eye drops in conjunctivitis. J Altern Complement Med. 2000 Dec;6(6):499-508.

Tauber S, Cupp G, Garber R, et al. Microbiological efficacy of a new ophthalmic formulation of moxifloxacin dosed twice-daily for bacterial conjunctivitis. Adv Ther. 2011;28(7):566-74.

Visscher KL, Hutnik CM, Thomas M. Evidence-based treatment of acute infective conjunctivitis: Breaking the cycle of antibiotic prescribing. [Review]. Can Fam Physician. 2009;55(11):1071-5.

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Review Date: 4/1/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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