Conjunctivitis
The conjunctiva is the thin transparent film covering the white of the eye and the inside of the eyelids.
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Medicines commonly prescribed for Conjunctivitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 10 mg/coated tabletActive substance: cetirizineManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: cetirizineManufacturer: Mabo Farma S.A.Prescription requiredDosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Retrain, S.A.U.Prescription required
The conjunctiva is the thin transparent film covering the white of the eye and the inside of the eyelids. When it becomes inflamed, the vessels running through it widen and show through, and the eye turns red. In the overwhelming majority of cases this is a harmless business that clears up by itself in a week or two. But the same red eye occasionally hides conditions in which the clock is running in hours and a delay costs sight. Telling one from the other is not difficult once you know what to look at, and that is what most of this text is about.
How it usually looks
Both eyes are affected more often than one, though it frequently starts on one side and the second joins in a day or two later. The typical picture:
- the white of the eye is red or pink, with the vessels evenly widened and the colour strongest towards the lids;
- a gritty, burning feeling, as though something were in the eye;
- watering;
- discharge, which may be clear and watery, mucous, or thick enough to glue the lashes together so that the eyes are hard to open in the morning;
- itching, sometimes maddening;
- swollen lids and discomfort in bright light.
What ordinary conjunctivitis does not produce: genuine deep pain inside the eye, falling vision, a pupil that has changed shape or stopped reacting, a cloudy cornea. Vision can blur slightly because of mucus sitting on the surface, but it clears when you blink, and that is not the same thing as a lasting decline.
Three different causes, and why the difference matters
Viral conjunctivitis is the commonest of the three. It usually comes along with a cold, the discharge is watery, the eyes feel as if they are burning, and the lymph node in front of the ear is often enlarged. It starts in one eye and moves to the other. It is highly contagious and settles on its own within a week or two, sometimes dragging on longer. Antibiotics do nothing for it whatsoever.
Bacterial conjunctivitis gives thick yellow or greenish discharge, the lashes stick together overnight, and once the eye is cleaned the pus builds up again through the day. In otherwise healthy people it too often clears without treatment in a few days, but this is the form in which antibiotic drops make sense; they are prescribed when things are not improving, when there is a lot of discharge, or when there are particular circumstances to take into account.
Allergic conjunctivitis gives itself away by the itch, which is the leading symptom: both eyes itch strongly and equally, the discharge is clear, and sneezing and a blocked nose often come with it. It appears seasonally with pollen or all year round with dust, animal hair or cosmetics. It is not contagious and needs no antibiotics; it needs anti-allergy treatment.
There is also irritation with no infection behind it at all: chlorine in a swimming pool, smoke, wind, welding without eye protection, too many hours at a screen, or a chemical splashed into the eye. That last one is a case apart. If any chemical gets into the eye, and especially an alkali such as lime, a household cleaner or cement, rinse the eye immediately with clean water for at least twenty minutes without waiting for a doctor, and go straight for help afterwards.
A red eye that needs a doctor immediately
This is the most important section here. What follows is not conjunctivitis, and waiting a week in the hope that it clears on its own is not an option.
Seek urgent care the same day if even one of these is present:
- vision has got worse and does not come back after blinking, or there is a veil, spots, or haloes around lights;
- pain deep inside the eye rather than surface burning, particularly if it is severe or spreads to the temple and the brow;
- bright light hurts and makes you screw the eye shut;
- only one eye is red, and the redness forms a ring around the iris rather than covering the whole white;
- the pupils are unequal in size, or one pupil reacts poorly to light;
- a whitish or cloudy spot is visible on the cornea;
- a severe headache with nausea and vomiting alongside the red eye;
- a lid that has suddenly swollen, reddened and become painful, with fever, with pain or inability to move the eye, or with the eye looking pushed forward;
- blisters on the forehead, the lid or the tip of the nose, which is how shingles affecting the eye begins;
- an injury to the eye, a chemical splash, or any suspicion that something has entered the eye itself;
- you wear contact lenses and the eye hurts, dislikes light or sees less well.
Behind these signs sit inflammation of the cornea, inflammation of the uvea, an acute attack of glaucoma, and infection of the tissues around the eye socket. All of them are treatable, provided they are dealt with at once.
What you can do at home
For ordinary conjunctivitis, home care is usually all that is needed.
- Wipe away the crusts with a clean damp cotton pad or gauze, working from the outer corner of the eye towards the inner one. Use a separate pad for each eye and throw it away straight afterwards.
- Hold a cool damp compress on the eye for a few minutes; it takes the edge off the burning and the swelling. With thick, purulent discharge a warm one feels better and does more good.
- Use preservative-free lubricating drops or artificial tears: they dilute the discharge and take away the gritty feeling.
- Take your lenses out and leave them out until the eye is completely settled.
- Give up eye make-up meanwhile, and it is best to throw away whatever you were using when the trouble started.
- Do not rub your eyes, which is how the infection reaches the other eye and everyone around you.
Things worth avoiding: drops left over from a previous episode or borrowed from someone else, covering the eye with a patch, rinsing it with tea, breast milk or home-made solutions, and using steroid drops that nobody prescribed, since with some causes of a red eye these make matters dramatically worse.
When medicines are needed
The choice depends on the cause, and this is a case where there is no such thing as all-purpose eye drops. Viral conjunctivitis has no treatment as such: lubricating drops and compresses help, and time does the rest. Bacterial conjunctivitis may call for antibiotic drops or ointment, particularly if there is a great deal of pus, if nothing has improved over several days, if only one eye is involved, or if there are other illnesses in the background. Allergic conjunctivitis responds to antihistamine drops and to mast cell stabilisers, with antihistamine tablets added when the nose is badly affected; alongside that it is worth working out what the allergen is and removing it where possible.
The particular medicine is chosen by a doctor or pharmacist, taking account of age, pregnancy and other treatment. For small children many products need a prescription, so when a young child's eye is inflamed it is more sensible to see a specialist at once than to pick out drops yourself. If seven days into treatment nothing has changed, or things have got worse, go back to the doctor: it means the cause is something else.
Contact lenses are a separate conversation
In anyone who wears lenses, a red eye is never assumed to be simple conjunctivitis. Bacterial infection of the cornea develops underneath a lens and can leave a scar within a day or two, permanently spoiling the sight. Lenses plus pain, lenses plus sensitivity to light, or lenses plus reduced vision means an eye specialist the same day.
With any redness of the eye, the lenses come out immediately and stay out until you have fully recovered and for a further day after that. The lenses and the case in use when the trouble began get thrown away, because they are already contaminated. Separately, and always: never sleep in lenses, never top up the solution instead of replacing it, and never rinse lenses in tap water. That is precisely how the most severe corneal infections come about.
How to avoid passing it on
Viral and bacterial conjunctivitis spread easily through hands, towels, pillows, shared drops and phone screens. A person stays infectious for as long as there is discharge and redness.
- Wash your hands with soap after every time you touch your eyes and before putting drops in.
- Keep your own towel and pillowcase, and wash them often and hot.
- Do not share cosmetics, drops, lenses or glasses.
- Cover your mouth when coughing and sneezing, and throw tissues away straight away.
- The tip of the dropper bottle must not touch the eye or the lashes.
Staying at home for ordinary conjunctivitis is not usually necessary, for adults or for children, provided the person feels reasonably well in general. It is worth staying in if someone feels genuinely unwell, or if an outbreak has started in a nursery or school and the institution asks for it.
Cases that fall outside the usual rule
Red, swollen, discharging eyes in a baby in the first month of life are always an emergency. In newborns the infection may be caused by organisms picked up during birth and can damage the cornea within days. Treating it yourself is out of the question; the baby must be seen by a doctor immediately.
In adults, conjunctivitis caused by sexually transmitted infections deserves separate attention, chlamydial and gonococcal above all. Suspect them when there is copious pus that rebuilds within hours, marked swelling of the lids, an obstinate course lasting more than two or three weeks, or one-sided redness in a young person, especially alongside genital discharge or burning on passing urine. This kind of conjunctivitis does not respond to ordinary drops; it needs systemic treatment and investigation, and both partners have to be treated. Gonococcal infection can damage the cornea very quickly, so getting help is urgent.
One more situation is a red eye in someone whose immune system is weakened, who has had eye surgery, or who has a rheumatic disease. Here the threshold for contacting a doctor should be markedly lower than usual.
Online consultation
A screen is a convenient way to settle the main question: is this ordinary inflammation that can be seen through at home, or the kind of red eye that needs an eye specialist? The doctor will ask about the nature of the discharge, the itch, the vision and the pain, ask you to show both eyes in good light and to pull the lower lid down, and check on lenses, a recent cold, allergies and contacts. Online is also the sensible place to work out whether drops are needed at all and which ones, how to care for the eye properly, how long this will last, and when to go back to nursery or work. The signs on the emergency list are not assessed by video; with those you go to a doctor in person straight away.
This material is for information only and does not replace medical advice.
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