Conjunctivitis, which is also known as Pink Eye, we have discussed in past posts. It means that the eye or eyes are red and inflamed but does not tell us anything about what caused the conjunctivitis.
One of the most common causes of conjunctivitis or pink eye is a viral eye infection. There are many strains of viruses that can cause a Viral Conjunctivitis. We need to be clear that antibiotics are a waste of time in treating Viral Conjunctivitis, as antibiotics are only effective against bacteria.
What are the signs and symptoms of Viral Conjunctivitis?
Gritty, Itchy feeling
Sensitive to light
Swelling of a gland adjacent to ear (preauricular node)
White spots on cornea (infiltrates) in more significant presentations
Pressing around the gland adjacent to the ear (preauricular node, photo on left) will give the eye practitioner a good idea whether you have a viral conjunctivitis, as it is often raised and tender.
Having white spots (infiltrates, photo on right) in the cornea is a sign of the immune system trying to kill off the virus, going in overdrive. This can be extremely uncomfortable and even causes blurry vision. Aggressive treatment is normally indicated.
What is the treatment for Viral Conjunctivitis?
This can vary depending on how intense the presentation and the symptoms are. We need to remember that if the diagnosis is viral conjunctivitis, then antibiotics are not part of the treatment plan.
If you want to avoid grief it is important that you do not just go to the pharmacy and allow them to recommend eye drops, which are usually Chlorsig. This particular eye drop is one of the most commonly prescribed in Australia and it probably only is effective on around 5% of cases of conjunctivitis. To be effective to Chlorsig the conjunctivitis or red eyes need to be caused by a bacterial infection. Very few red eyes are bacterial infections, especially in adults.
As a word of warning!
If you are wearing contact lenses and experience a red eye or eyes it is critical to seek an appointment from a therapeutic optometrist. This is because the most common bacterial infection related to contact lenses is pseudomonas. It is NOT sensitive to Chlorsig.
Now back to viral conjunctivitis.
Viral Conjunctivitis treatment is normally termed palliative. This means that anything that is given to the patient is to make them more comfortable. The disease process in other words just needs to run its course, while the immune system finally recognises the offending virus and over a period of 2 weeks develops an antibody response, which finally kills it off.
Palliative Treatment for Viral Conjunctivitis:
- Cold Compresses - this is probably best done using a gel sporting injury cold pack, that is stored in the freezer. It needs to be wrapped once in a clean tea towel and then moulded into the eye sockets for at least 10 minutes once or twice a day.
- Unpreserved Lubrication - This forms the basis of nearly any eye irritation. The key though is using eye drops that do not have preservatives. All too often we see patients that have had all forms of conjunctivitis that is treated with preserved eye drops. The preservatives can set off an allergic or toxic conjunctivitis. Instead of having one problem now the patient has two forms of conjunctivitis. So where possible, use eye drops that have NO PRESERVATIVES!
Anti-inflammatory treatments for Viral Conjunctivitis:
Inflammation which is caused by the aggressive immune response of the eye in defense against the viral infection is what is responsible for all the symptoms that the patient perceives. What we need to remember though, is that it is the inflammatory response that ultimately will kill off the virus. It is a balancing act for the treating therapeutic optometrist to try and keep the patient comfortable, whilst allowing the immune system to do its job. If anti-inflammatory treatment is chosen, it sometimes means being on treatment for a few months and weaning off gradually. Stopping the eye drops too quickly sometimes can cause a rebound reaction.
- Corticosteroid eye drops - these are very effective in relieving most of the annoying symptoms of viral conjunctivitis. This is especially true if white spots (infiltrates) affect the cornea. There are various strengths of steroid eye drops starting from unpreserved prednisolone to the king of steroid eye drops Prednefrin Forte.
- Non-steroidal eye drops - these also suppress inflammation but are not as potent as steroids. If possible non-preserved eye drops should be given to avoid irritation from preservatives.
Novel Treatment for Viral Conjunctivitis:
A new treatment for Viral Conjunctivitis seems to be using a single treatment of Iodine solution (Betadine 2.5% - 5% concentration). Iodine solution is very irritating to the eye so anaesthetic must be used before the treatment. Once the eye is anaesthetised (takes 30 seconds), a few drops of Iodine solution are instilled, the patients is asked to move the eye around and blink to make sure all parts of the eye are covered.
After 60 seconds the eye should be rinsed out carefully with unpreserved saline solution. Steroid or non-steroidal anti-inflammatory eye drops should then be used for a few days to keep things comfortable.
This treatment has not been investigated fully to date and treatment protocol is still being investigated, but it seems that it will revolutionise Viral Conjunctivitis treatment.
If you have a red irritated eye, the best follow up is an appointment with a certified therapeutic optometrist. Dr Jim Kokkinakis is available for conjunctivitis appointments usually on the same day. Call 9290 1899 or BOOK AN APPOINTMENT ONLINE NOW.