What is it?
Conjunctivitis means an inflammation of the conjunctiva layer. This layer covers the white of the eye and the inside surface of the eyelids. Conjunctivitis which is due to bacteria causes reddening and stickiness of the eye. It feels sore and vision is slightly blurred. On waking, the eyelids need to be pulled apart. In conjunctivitis which is due to a virus infection, the eye is pink and watery rather than sticky.

In bad cases a swelling comes up in front of the ear on the affected side. The surface of the clear cornea at the front of the eye can also be affected by infections. This is called keratitis. Severe bacterial or virus infections may cause a corneal ulcer. The eye becomes painful and very sensitive to light. Vision may become very blurred.

How does it occur?
In bacterial or viral conjunctivitis, an infectious organism invades the conjunctiva layer. The conjunctiva swells and reddens as it becomes more inflamed. A bacterial corneal ulcer happens when an infection breaks through the surface layer, spreading into deeper corneal tissues. The ulcer causes inflammation within the eye itself. Viral corneal infections affect the cornea shortly after the conjunctiva is infected. Vision is blurred. The eye is especially painful when the surface layer breaks down. A particular type of corneal infection due to the herpes simplex virus can spread readily to the deeper tissue of the cornea and cause scarring and inflammation within the eye. This infection is an important cause of loss of vision in younger people.

Why does it occur?
A strong infection can spread easily in bacterial and viral conjunctivitis. However, an eye with a deficient tear film, a blocked tear duct, or a turned out lower lid makes it more vulnerable to the organisms. A bacterial corneal ulcer can result from severe conjunctivitis. Any injury to the corneal surface makes it more likely. An inability of the eye to close properly or a loss of nerve sensation of the eye can also be a cause. Wearing soft contact lenses for long periods is often responsible and is therefore not a safe practice. Soft contact lenses should not be worn overnight, whatever the optician says. Herpes simplex virus corneal infection affects patients who have had herpes conjunctivitis in the past. The virus rests quietly within nerves near the eye, and reinfects the cornea when the individual becomes ill or stressed. These infections may be very contagious, especially in the case of certain viruses (adenovirus). Use of separate face towels and avoiding direct contact is important.

Treatment Involved …
A swab may be taken to confirm whether conjunctivitis is due to a virus or bacteria, especially in babies. Treatment is usually by antibiotic drops or ointment put into both eyes every one or two hours until the infection clears. If a diagnosis of corneal ulcer has been made, it will require hospital admission. Regular eye drop administration and antibiotic tablets are then prescribed. Acyclovir ointment is the favoured treatment for herpes simplex corneal disease. Dilating drops are given to relax the pupil. In some cases, a special weak steroid drop is also used. It is vital that steroids are not tried as a general remedy for a red eye. This would risk making herpes disease very much more severe and even lead to blindness. Bad cases can develop scarring of the cornea and may later need a corneal graft operation.

During Treatment …
Improvement occurs within days for a bacterial and after some weeks for a viral conjunctivitis. Sometimes the drops cause an allergic reddening and crusting of the eyelid skin. Corneal ulcer usually settles within a week if treatment is started promptly. If not, problems can become severe. The infection can penetrate within the eye and scarring takes place. Though herpes simplex may improve quickly on treatment, careful follow-up is needed. If symptoms return, contact the doctor promptly. Some further treatment is likely to be needed. Further attacks usually worsen vision.

If Left Untreated …
Even without treatment, bacterial and viral conjunctivitis normally get better within 2 or 3 weeks. An untreated corneal ulcer can worsen quickly. If the infection goes deeply enough to enter the eye, vision can be permanently damaged. For herpes simplex, withholding treatment would cause the scarring and inflammation to be more severe, and vision would become much worse. Never use steroid eye preparations without the approval of the doctor.





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