Conjunctivitis or conjunctivitis is an inflammation of the conjunctiva located in the eye. Especially the strongly reddened eyes are a typical sign of conjunctivitis. The causes are varied and range from bacterial inflammation to allergic reactions. Viruses can also lead to conjunctivitis of the eye through infection.
What is conjunctivitis?
Conjunctivitis is the most common disease of the conjunctiva in the eye and should be examined and treated by an ophthalmologist. Conjunctivitis, or conjunctivitis, is an inflammation of the conjunctiva of the eye. The conjunctiva itself covers the outer shell of the eyeball as well as the inner side of the eyelids. This transparent mucous membrane produces the moist liquid mucus necessary for the eye, which adheres to the eye as a tear film. The purpose is to reduce friction when moving and closing the eyes. The conjunctiva is a thin, delicate, and transparent mucous membrane that covers the inside of the upper and lower eyelids and the front half of the eyeball, ending at the edge of the cornea located midway between the lids. While it is firmly fused to the underlying tissue on the inner side of the eyelids, it lies loosely on the eyeball. When folding over from the inside of the eyelids to the eyeball, the conjunctiva forms sac-like cavities, also called conjunctival sacs. Eye drops and ointments can be conveniently placed in the lower conjunctival sac for treatment by pulling the lower eyelid down slightly with the fingers and turning it outward. In the case of inflammation, the conjunctiva, which is transparent in the non-inflamed state and makes the eyeball appear white with the exception of the cornea, is supplied with much more blood. It then takes on a red color and becomes opaque, so that the underlying white sclera can no longer shine through and the eyeball appears pathologically red. The conjunctiva is also responsible for the immune defense of the eye, so that in the case of conjunctivitis, the cornea and eyelids can also become inflamed. Since the eyes or the conjunctiva are relatively unprotected in the body, they are often susceptible to external germs and stimuli. Seen in this light, it is hardly surprising that conjunctivitis is one of the most common diseases of the eye. Typical are especially the strongly pronounced red eyes in conjunctivitis.
Causes
Conjunctivitis can have a variety of causes. In most cases, conjunctivitis is triggered by viruses, fungi, parasites (e.g. worms) or bacteria and is somite an infectious disease. Furthermore, allergies and environmental stimuli can also be triggers for conjunctivitis. These are mainly drafts, injuries, smoke, dust and substances. In rare cases, conjunctivitis also occurs in the context of another eye disease. Age-related eye disorders are also a cause. Conjunctivitis can vary regionally and temporally in allergic causes, depending on the occurrence of allergens or pathogens. As already mentioned, both external damage and internal diseases can be considered as a cause. External damage includes, for example, harmful effects of dust, smoke, foreign bodies, chemical vapors, glare, poor or inadequate lighting conditions, drafts, irritation due to severe rubbing of the eyes, and so on. Heavy smokers and people who are forced to stay in the company of so-called chain smokers can also get conjunctivitis. Since conjunctivitis quite often tends to become chronic, it is necessary to eliminate the external harmful influences. Most of the external damages often lead to conjunctivitis especially when there is already a certain susceptibility of the conjunctiva. Such susceptibility may be caused, for example, by a slight refractive error of the eyes, of which the patient is not aware because it causes only a slight visual impairment. In such cases, if the correct glasses or contact lenses are prescribed, the condition can be corrected very quickly. The same is true for people with normal vision after the age of 45, when the so-called presbyopia sets in. Many of them neglect to wear glasses for close work, or they use glasses whose lenses have already become too weak, thus unknowingly contributing to chronic conjunctivitis.When reading and writing, the main thing is to ensure that the field of vision is well lit, which is best achieved by using an adjustable floor lamp. However, the light must not dazzle. In many cases conjunctivitis is also caused by pathogens (bacteria). If it is very malignant bacteria, such as toxic pus germs, diphtheria bacilli, gonorrhea germs, etc., a violent inflammatory process can pass from the conjunctiva to the cornea, melting it down, so to speak, and penetrating into the interior of the eyeball. Only intensive specialist treatment can stop such violent inflammatory processes and save the eyes. Preventive measures are taken to prevent newborn children of sexually ill mothers from contracting such inflammation, which in earlier decades usually led to blindness. However, it is not uncommon for general infectious diseases, such as measles, typhoid, etc., to be accompanied by conjunctivitis. In all these cases, the pathogens must be determined by microscopic examination of the conjunctival secretion in order to be able to carry out targeted treatment. Finally, conjunctivitis can also be caused by numerous substances and agents with which the patient comes into contact and to which he is hypersensitive or allergic. These include first and foremost flour dust and other types of dust, e.g. also pollen, which can cause hay fever and conjunctivitis, cosmetic products, oil vapors, gasoline, chemicals, etc., the last of which very often get onto the conjunctiva through eye rubbing during work. Hypersensitivity and allergies to certain foods, such as strawberries, tomatoes, etc., can also cause conjunctivitis. Severe rhinitis is also often associated with this condition. In addition, the tear ducts may be blocked, which can equally cause persistent annoying tearing and conjunctivitis.
Symptoms, complaints and signs
Conjunctivitis is manifested by several symptoms. The first sign is redness of the eye. Due to increased blood flow to the conjunctival vessels, there is a visible, usually bright red discoloration at the edge of the iris. If deeper layers are inflamed, the iris margin appears bluish to reddish. Accompanying the redness, the lacrimal duct secretes purulent or mucous secretions, which often causes the eye to be stuck shut. If an allergic reaction is the cause, the conjunctiva may swell. These so-called papillae are accompanied by a strong foreign body sensation. In severe inflammations, a spasmodic closure of the eyelid may occur. Allergic conjunctivitis is characterized by itching, sudden tears and accompanying symptoms such as rhinitis and sneezing. In bacterial conjunctivitis, there may also be purulent collections in the corners of the eyes. The viral form usually occurs on both sides and is manifested by swollen eyes and severe itching. Depending on the degree of inflammation, the eye may water more or less intensely and secrete mucus and purulent secretions mainly at night, often causing the eyelids to become completely stuck together so that they can only be opened with great difficulty in the morning. In severe cases, the eye can no longer be closed – the conjunctiva appears swollen glassy. In the case of viral or bacterial conjunctivitis, there may be small protrusions inside the eyelids. In addition, there is sensitivity to light and an annoying burning and itching sensation, as well as a certain foreign body sensation, as if there were sand in the eyes. All these phenomena are particularly pronounced in acute conjunctivitis. In chronic conjunctivitis, on the other hand, they are only slightly developed. Sometimes redness of the conjunctiva can be seen only on the inner side of the eyelids, while the conjunctiva of the eyeball looks completely normal. Accordingly, the symptoms of chronic conjunctivitis are also less pronounced and generally occur only during activities that strain the eye, for example, reading, writing and watching TV plus computer, furthermore, smoking or in rooms where people smoke, moreover, in colder weather, wind as well as bright sunlight.
Course
Untreated conjunctivitis usually has a mild course. Due to the body’s self-healing process, severe consequences for the eye and lifelong impairment of vision rarely occur.Only sometimes can a loss of visual acuity occur if the cornea of the eye has been injured or inflamed. However, if pain occurs or further complications arise, a doctor should be consulted immediately.
Complications
Complications are more common with viral conjunctivitis than with bacterial conjunctivitis because healing takes more time and symptoms are more severe. One possible late consequence of viral conjunctivitis is corneal opacity. This visual disorder can vary in severity and can have a significant limiting effect on vision if transparency is greatly reduced. The formation of scars, especially observable in chlamydial infection, near the lacrimal glands and ducts also impairs the moistening of the eye. Chlamydia infections are also often chronic and make it necessary to also subject the partner of the affected person to treatment. Depending on the state of the immune system and the type of pathogen, bacterial infections can also have consequences that threaten blindness. The cornea can become inflamed, as can the bags under the eyes. They are located in the inner corner of the eye. Consequential diseases such as middle ear infections or meningitis are also possible. In any case, it is advisable to follow a treatment imposed by the doctor with eye drops or antibiotics until the end of the prescribed days. Even if symptoms improve, premature discontinuation may lead to renewed conjunctival inflammation.
When should you see a doctor?
If the eyes are red and burn or itch in certain situations, for example after long screen work or when staying in strongly heated rooms, this is not yet a cause for concern. It is also not necessary to see a doctor under these circumstances. Usually a walk in the fresh air is enough for the eyes to recover. However, there are a number of situations in which burning or reddened eyes should be presented to the doctor immediately. Conjunctivitis caused by pathogens such as bacteria, viruses or fungi is usually highly contagious. If your child comes home from daycare or school with red or irritated eyes, it is very likely that conjunctivitis is present. In this case, a visit to the doctor is urgently recommended. If the suspicion is confirmed, the school administration should be informed. The doctor must also be consulted whenever changes occur in the eye after a trip abroad to tropical regions. In this case, the affected person may have become infected with a dangerous parasite. Herpes infections that spread to the eye can be particularly unpleasant and also dangerous. In these cases, a doctor must be consulted immediately to prevent serious complications, including loss of vision.
Treatment and therapy
The treatment or therapy of conjunctivitis depends on its specific cause. In addition, the severity and course of the disease are also important in the treatment. Therefore, treatment is differentiated based on bacterial and viral causes, as well as external irritants and allergic conjunctivitis. According to the numerous causes, there is a whole range of treatment prescriptions. In general, the general practitioner or ophthalmologist prescribes mild disinfecting and anti-inflammatory eye drops and eye ointments in the beginning, because this already cures the majority of patients. However, in many cases it is necessary to try several or a whole series of remedies. Since it is only possible to determine more serious causes through repeated ophthalmologic examinations, it is especially advisable for those suffering from chronic conjunctivitis to keep visiting the ophthalmologist even if the previously prescribed medications have not helped. Beyond that, however, every affected person should make an effort to eliminate the damaging influences, whether at work or at home. In the case of conjunctivitis caused by bacteria, no further treatment is usually necessary, as it heals on its own. Nevertheless, the doctor can prescribe antibiotic eye drops or ointments that have a supportive effect. Only in severe cases should antibiotics be resorted to. These can then be administered as tablets or eye drops. There is no direct treatment for virus-related conjunctivitis.Only manually administered tear fluid and cold compresses can alleviate the discomfort. The same procedure applies to conjunctivitis caused by external stimuli, such as drafts. In the case of an allergic cause, the allergy-causing substances, such as pollen, should be avoided. Here, too, cold compresses and artificial tears are particularly helpful against the acute symptoms. For a lasting improvement, antihistamines or mast cell stabilizers are prescribed by the doctor. As with all forms of allergy, hyposensitization against the causative allergens is also an option here.
Outlook and prognosis
Depending on the cause of the disorder as well as personal circumstances, the course and prognosis of conjunctivitis can vary widely. Simple bacterial inflammation of the conjunctiva is almost always successfully treated with antibiotic-containing eye drops after identification of the causative agent. The symptoms then usually disappear completely within a few days. A prerequisite for this, however, is that the patient also strictly follows the treatment instructions of his physician. In particular, the eye drops should not be discontinued without authorization as soon as the symptoms have disappeared. As a rule, the treatment must be carried out over a longer period of time in order to completely cure the inflammation and prevent a relapse. A new outbreak of the infection often results in a more severe course, and conjunctivitis can also become chronic. Conjunctivitis caused by viruses is more difficult to treat, and recovery can often take weeks. During this time, symptoms such as reddened, watery or painful eyes may recur. Normally, however, viral infections heal without late consequences. In exceptional cases, especially in people with a severely compromised immune system, very severe and persistent courses can occur, and blindness due to conjunctivitis cannot be completely ruled out. However, this complication now occurs almost exclusively in patients in the developing world.
Follow-up
Conjunctivitis is a disease that may well flare up again and again after it has subsided. Consistent aftercare is recommended to protect the eyes and prevent discomfort before it occurs. This can be done by the patient himself, but also by the ophthalmologist. In uncomplicated cases, the experienced general practitioner can also examine the eyes for the condition of the conjunctiva. If necessary, he advises to visit the family doctor again. Follow-up care includes, above all, protecting the sensitive conjunctiva of the eye from further irritation. Thus, when washing the face, the use of harsh detergents, especially those with a high alcohol content, should be avoided. In addition, it is best to refrain from applying makeup to the eyes for a while to prevent particles of kohl, mascara or eye shadow from getting into the eye. Those who sweat a lot during sports can use a headband to prevent drops of sweat from running into the eye. Pollen allergy sufferers who have developed conjunctivitis due to contact with pollen should avoid the allergens as much as possible as part of their aftercare. If the conjunctivitis was caused by sun exposure, for example in the high mountains, sunglasses are a valuable companion in the aftercare. Medications prescribed by the ophthalmologist for local application can still be used in aftercare after consultation. The same applies to eye moisturizing agents.
What you can do yourself
Medical treatment of conjunctivitis can be supported by various home remedies and self-help tips. One of the most important measures is increased hygiene. On the one hand, this can prevent the spread of the inflammation to the other eye and to fellow human beings. On the other hand, lukewarm water reduces the oppressive foreign body feeling and quickly flushes out pathogens. Alternatively, an eye bath in which the eye is immersed in a glass of water can also help. If the inflammation is severe, it is recommended to wear protective goggles. In general, contact with irritants such as wind, chlorinated water, smoke or great cold or heat should be avoided. Antiseptic agents (such as Bibrocathol, povidone and zinc sulfate) from the pharmacy have an anti-inflammatory effect and help especially in the first days of inflammation. In the further course, painful eye rims can also be dabbed with some black tea.Other proven home remedies are, for example, eyebright, garden rue, calendula ointment or curd compress. Tip: use woolen cloths or disposable handkerchiefs to dry the eyes and dispose of them after use. If the inflammation still spreads or has not subsided after one week at the latest, another visit to the ophthalmologist is recommended.
