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Bacterial conjunctivitis

Conjunctivitis means “inflammation of the conjunctiva”1.

The conjunctiva is the transparent membrane that covers the white areas of the eye and the inside of the eyelids2.

Conjunctivitis can be noninfectious (for example allergic conjunctivitis or irritative conjunctivitis) or infectious, related to either viruses or bacteria1.

Bacterial conjunctivitis is a common disease worldwide, more frequent in children (2/3 of the cases) than in adults3.

causes

What can cause bacterial conjunctivitis?

Bacterial conjunctivitis in a contagious disease, that most often occurs in otherwise healthy individuals3.
The infection may be transmitted from infected individuals or may result from an abnormal development of bacteria that are naturally present on the skin, in the nose or on the eye surface5.

Some risk factors increase the risk of bacteria transmission:

  • Poor hygienic habits (especially not washing one’s hand, as contaminated fingers are a common route of transmission of the bacteria in the eye5,
  • Contaminated cosmetics (especially old ones and/or shared between several people4,
  • Crowded social conditions such schools, military barracks… that imply close contacts between individuals6.
  • Diseases and conditions that weaken the ocular surface encourages bacteria to take hold and grow: dry eye, blepharitis, recent ocular surgery, ocular foreign bodies and chronic use of eyedrop medications6.
  • Conditions that compromise the immune defenses, like diabetes7, favor all types of infections, including in the eye6.
  • Contact lens wear is a common risk factor for bacterial eye infection, especially if: sleeping with the lenses, inadequate maintenance of contact lenses and contact lenses case, failing to discard the contact lenses in a timely manner, and exposing the contact lenses to water (eg, swimming, showering, tap water)3.

The most common pathogens for bacterial conjunctivitis in adults are staphylococcal species, mostly involved in skin and eye infections, followed by other bacteria that are otherwise mostly involved into respiratory common infections such as bronchitis, pneumonia …6

symptoms

What are the symptoms of bacterial conjunctivitis?

Bacterial conjunctivitis often starts in one eye, and spreads to the other eye within a few days7.

It usually causes eye redness with a yellowish or greenish sticky discharge throughout the day. The eyelids may become swollen and stuck together when waking. Vision may be mildly blurred by secretions, but the visual acuity is not reduced6,7.

The course of the disease usually lasts 1 to 2 weeks6.

Bacterial conjunctivitis seldom leads to complications. However, it may spread to the cornea (transparent membrane that covers the iris and pupillae at the center of the eye).

In people with recent eye surgery, the infection may also extend to the inner parts of the eye. Both situations may be sight threatening3.

diagnostic

How to diagnose a bacterial conjunctivitis problem?

In the majority of cases it is a clinical diagnosis and does not require sampling for germ identification6.
The diagnosis of bacterial conjunctivitis is clinical, based on the redness of the eye(s) with purulent discharge, which is strongly evocative of bacterial infection5.

The bacterial origin of the conjunctivitis may be further suspected and distinguished from allergic and viral causes if the eyelids stick together, if there is no itching, no history of previous conjunctivitis, and in people wearing contact lenses5.

If you consult an ophthalmologist, he or she will perform a thorough eye examination to assess the extent of the infection, or the possibility of another diagnosis. Sometimes a sampling of the eye secretions will be done to identify the bacteria et prescribe the appropriate treatment.

treatment

What treatments are available for bacterial conjunctivitis?

Most cases of acute bacterial conjunctivitis are self-limited and will clear within 10 days without treatment1,5,6.

Treatment of bacterial conjunctivitis should primarily involve eyewash with saline and antiseptic eyedrops7,8.

Eyedrops with antibiotics are often prescribed, although they do not improve the outcome, which is spontaneously good, but they may accelerate symptoms resolution and reduce the risk of contagion1.

Conversely, to avoid unnecessary waste of antibiotics that may lose their efficacy if overused, guidelines claim that they should be reserved for severe forms or patients with risk factors or if the symptoms do not resolve after a few days with mere eyewash and antiseptic eyedrops3,8.

In very specific cases, antibiotics in tablets may be prescribed3.

Both bacterial and allergic conjunctivitis can make the eye(s) turn red.

The most commonly reported symptom in allergic conjunctivitis is itchiness. The discharge is clear and watery. Crusting in the mornings is minimal, and there is no pain or vision trouble. Whereas bacterial conjunctivitis is not or mildly itchy and the discharge is yellowish or greenish3.

Furthermore, allergic conjunctivitis is frequently associated with other allergic symptoms, like hay fever or asthma. As allergy is a chronic condition, recurrent episodes are commonly observed9.

But it may happen that allergic conjunctivitis become superinfected by a bacterium and evolves into a bacterial conjunctivitis.
You shall consult an ophthalmologist:

  • if your sight becomes more blurred over time, or with wavy lines or flashing7

  • If the pain and redness are getting a lot worse7,

  • If the light starts to hurt your eyes (photophobia)7,

  • If the redness is intense in one or both eyes7.


 

 
No, you shall not wear eye makeup until complete symptoms disappearance7.

Bacteria can live in makeup, and this can cause bacterial conjunctivitis and even a dangerous infection of the cornea. Throw away your makeup if you have an eye infection and replace it by new items4.

Never share eye makeup with other people4.
You should stop wearing your lenses as soon as you notice something unusual in your eyes5, and refrain from wearing them back until you have no symptom left7, which usually takes 1 to 2 weeks6.
Bacterial conjunctivitis is a contagious condition, and may be transmitted by people having different locations of infections: eye infections, but also skin and respiratory infections.

Thus, people with any of these infections, as well as people living close, such as relatives, friends, colleagues…  shall perform proper hygiene and frequent hand washing6.

The period of communicability varies from 2 to 7 days5. Thus during a week after symptoms onset:

  • Don’t share anything that can come close to the eyes with anyone else: flannels, pillows, towels, eyedrops, makeup…7

  • Do not rub your eyes7.

  • Wash your hands regularly with soap and water7. Always wash them before and after you eat, when you go to the bathroom, or after you sneeze or cough4.

  • Don’t attend work until symptoms have disappeared if you work with children, elderly people or with people having health issues, or if you handle food in your job7.

  • Wash pillows and face cloths in hot water and detergent7.

  • Use disposable paper tissues to wipe your eyes7.

In general, don’t hesitate to ask your pharmacist for advice if you have any eye symptoms.

On the other hand, if you experience one or more of these symptoms, you should see an eye specialist as a matter of urgency; -Moderate,-Severe pain, -Intense sensitivity to light, -Decreased vision, -Flashes of light, -Dark spots, -Sensation of a foreign object in the eye, -Trauma (injury, contusion, acid burn etc.), -Persisting or worsening symptoms despite appropriate treatment.

  1. Conjunctivitis. Prefered Practice Patterns. AAO (American Academy of Ophthalmology. file:///C:/Users/BAB/Downloads/Conjunctivitis%20PPP-1.pdf
  2. Hashmi MF et al. Conjunctivitis – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK541034/?report=reader
  3. Yeung KK & Dahl AA. Bacterial Conjunctivitis (Pink Eye). Medscape. https://emedicine.medscape.com/article/1191730-overview?form=fpf
  4. Boyd K et al. Conjunctivitis: What Is Pink Eye? American Academy of Ophthalmology https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis
  5. Azari AA & Barney NP. Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA. 2013 October 23; 310(16): 1721–1729.
  6. Feldman BH et al. Bacterial Conjunctivitis. EyeWiki – American Academy of Ophthalmology. https://eyewiki.aao.org/Bacterial_Conjunctivitis
  7. NHS – Patient information – Conjunctivitis (Bacterial and Viral) – https://www.esht.nhs.uk/wp-content/uploads/2020/12/0869.pdf
  8. AFSSAPS 2004 – Collyres et autres topiques antibiotiques dans les infections oculaires superficielles. Recommandations – https://www.em-consulte.com/article/28888/resume/collyres-et-autres-topiques-antibiotiques-dans-les
  9. Baab S et al. Allergic Conjunctivitis – StatPearls – NCBI Bookshelf – https://www.ncbi.nlm.nih.gov/books/NBK448118/?report=printable

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