Viral Conjunctivitis ^6,12

Viral conjunctivitis is most commonly caused by adenovirus. The most common strains cause a mild conjunctivitis with pharyngitis and fever, while more virulent strains may cause a severe conjunctivitis with corneal involvement causing keratitis.

Other viruses are herpes simplex virus, varicella zoster virus, Epstein-Barr virus, coxsackie and enteroviruses.

Bacterial Conjunctivitis³

Bacterial conjunctivitis is most commonly caused by Staphylococcus species, Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis. Poor hygiene, using contaminated cosmetics or physical contact with other people with the infection6 is often responsible.

Neonatal Conjunctivitis⁴

This occurs in newborn babies within the first 28 days of life, with the majority due to bacteria. The bacterial causes include sexually transmitted diseases agents (Chlamydia trachomatis and Neisseria gonorrhoea), microorganisms from the skin (Staphylococcus aureus) and the mother’s gastrointestinal tract, or toxic response to topical treatments applied to the eye.

Allergic Conjunctivitis

This occurs more commonly among people who already have seasonal allergies.

Giant papillary conjunctivitis is a type of allergic conjunctivitis caused by the chronic presence of a foreign body in the eye. People who wear hard or rigid contact lenses, wear soft contact lenses that are not replaced frequently, or have an exposed suture on the surface of the eye, are more likely to develop this form of Conjunctivitis⁷.

Chemical Conjunctivitis

This can be caused by irritants like air pollution, chlorine in swimming pools, exposure to noxious chemicals, and overuse of topical medications or cosmetics, or both⁷.

Cicatricial Conjunctivitis

Cicatricial conjunctivitis is chronic conjunctivitis that leads to scarring of the conjunctiva⁸.

Conjunctivitis Secondary to Immune-Mediated Diseases and Neoplastic Processes³

Advising people with infective conjunctivitis¹⁷:

• It is a self –limiting condition and settles without treatment within 1-2 weeks. If symptoms persist for longer than 2 weeks, seek medical advice and consult.
• Remove contact lenses until all symptoms and signs of infections are clear
• Lubricant eye drops can reduce eye discomfort
• To clean infected secretions from eyelids and eyelashes with cotton wool soaked in water.
• To wash hands regularly; avoid sharing pillows and towels to prevent the spread of infection. Mild bacterial conjunctivitis is usually self-limited, and it typically resolves spontaneously without specific treatment in immune-competent adults.

Treating Bacterial Conjunctivitis Can^3,18,19:

• Relieve symptoms
• Reduce the risk of sight-threatening complications
• Prevent the spread of infection
• Allow children back to school/nursery
• In younger patients, factors such as the need for children to attend day care/school and requirements for parents to attend work may contribute to the decision to treat¹³.
• The benefits of antibiotic treatment include quicker recovery, decreased transmissibility and early return to school or nursery. Sometimes bacterial conjunctivitis may not require treatment as the symptoms can resolve within 1–2 weeks⁶. However, treatment is associated with earlier infection clearance and symptom improvement.

Available Treatments for Bacterial Conjunctivitis¹²

The antibiotic eye drops commonly used to treat bacterial conjunctivitis differ according to mechanism of action, delivery and administration and who they can be prescribed for according to the individual licenses and approvals. Several classes of antibiotic eye drops are effective against bacterial conjunctivitis¹³:

• Chloramphenicol is effective against species that commonly cause bacterial conjunctivitis, including Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus viridans, Moraxella species and Enterobacteriaceae
• Fusidic acid is effective against species that commonly cause bacterial conjunctivitis, including Staphylococcus aureus, Streptococcus, Neisseria, Haemophilus, Moraxella and Corynebacteria
• Aminoglycosides, e.g. tobramycin, gentamicin are effective against gram-negative and gram-positive bacteria
• Fluoroquinolones, e.g. ofloxacin, ciprofloxacin, levofloxacin and moxifloxacin, are effective against species that commonly cause bacterial conjunctivitis, including Haemophilus influenza, Staphylococcus species, Moraxella catarrhalis, Escherichia coli, Pseudomonas aeruginosa
• Polymyxin B is effective for infections caused by Pseudomonas aeruginosa
• Macrolides, e.g. azithromycin, are effective against species that commonly cause bacterial conjunctivitis, including Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae
• Combination treatments are also available, including those that also contain a corticosteroid; these preparations should only be used with close specialist supervision

Find out how Fucithalmic® can be used to treat conjunctivitis.

Most viral conjunctivitis is related to adenoviral infection. Supportive therapy includes time honored treatment options: cold compresses, lubricants, and ocular decongestants.

Topical antibiotics are not routinely used to treat viral conjunctivitis, unless there is evidence of secondary bacterial infection. The risk of toxic and allergic reactions may outweigh the potential benefit of antibiotic use.

Topical steroids are specifically contraindicated for treating herpes simplex conjunctivitis .

• Topical steroids: Corticosteroids inhibit the inflammatory process (e.g., oedema, capillary dilation, and fibroblast proliferation). Widely employed in the treatment of acute ocular allergic disease, steroids are effective in relieving the acute symptoms of allergy; however, theiruse should be limited to the acute suppression of symptoms because of the potential for adverse side effects with their protracted use.
• Chronic use of topical corticosteroids can result in well documented associated complications.
• Topical vasoconstrictor/antihistamines: These agents cause vascular constriction, decrease vascular permeability, and reduce ocular itchingby blocking H1 histamine receptors. Anti-histamines reduce itching and vasodilation and help in relieving the signs and symptoms of allergic conjunctivitis.
• Topical non-steroidal anti-inflammatory drugs (NSAIDS): May be effective in reducing the signs and symptoms associated with allergic conjunctivitis.
• Topical mast cell stabilizers: These agents inhibit the degranulation of mast cells, thus limiting the release of inflammatory mediators, including histamine, neutrophil and eosinophil chemotactic factors, and platelet-activating factor.
• Immunosuppressants may be an effective treatment for patients with severe atopic keratoconjunctivitis.
• Systemic antihistamines: These agents are useful in certain cases of allergic response with associated lid edema, dermatitis, rhinitis, or sinusitis. They should be used with care because of the sedating and anticholinergic effects of some first-generation antihistamine drugs.
• Patients should be warned of these potential side effects .

The primary treatment for adults is systemic antibiotics as topical therapy alone is inadequate.

Patients' sexual partners should also be evaluated for the presence of infection and their treatment initiated as indicated. In cases of chlamydial infection affecting pre-adolescent children, the clinician should consider the possibility that sexual abuse has occurred .