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Conjunctivitis
Medical expert of the article
Last reviewed: 05.07.2025
Conjunctivitis most often occurs in children, less often in the elderly, and even less often in people of working age.
The causative agent of conjunctivitis usually enters the eye from the hands. Inflammation of the conjunctiva occurs with infection, allergy or irritation. Symptoms include conjunctival hyperemia and discharge from the eye and, depending on the etiology, discomfort and itching. Diagnosis is clinical; sometimes culture is indicated. Treatment depends on the etiology and may include topical antibiotics, antihistamines, mast cell stabilizers and glucocorticoids.
Inflammation of the conjunctiva (conjunctivitis) can be caused by any pathogen of purulent infection. Cocci (primarily staphylococci) most often cause the development of conjunctivitis, the infection proceeds more favorably.
[ What causes conjunctivitis?
Infectious conjunctivitis is most often viral or bacterial. Rarely, conjunctivitis is of mixed or unexplained etiology. Numerous factors can cause allergic conjunctivitis. Nonallergic conjunctival irritation can result from exposure to foreign bodies, wind, dust, smoke, fumes, chemical fumes, and other types of airborne pollutants, as well as intense ultraviolet radiation from electric arcs, sunlamps, and reflections from snow.
Conjunctivitis is usually acute, but both infectious and allergic conditions can be chronic. Conditions that cause chronic conjunctivitis include eversion, entropion, blepharitis, and chronic dacryocystitis.
The most dangerous pathogens are Pseudomonas aeruginosa and gonococcus, which cause severe conjunctivitis, which often affects the cornea. Acute infectious conjunctivitis can be caused by various microorganisms: diplococcus, streptococcus, Koch-Weeks bacillus, Loeffler bacillus.
Symptoms of conjunctivitis
Any source of inflammation causes dilation of the conjunctival vessels and lacrimation or discharge. Thick discharge can reduce vision.
Itching and serous discharge predominate in allergic conjunctivitis. Chemosis and papillary hyperplasia also suggest allergic conjunctivitis. Irritation or foreign body sensation, photophobia, or purulent discharge suggest infectious conjunctivitis. Severe eye pain suggests scleritis.
Acute conjunctivitis of various origins have many common symptoms - onset without prodromal phenomena, first in one eye, then in the other. Waking up in the morning, the patient cannot open his eyes - the eyelids are glued together with discharge. The mucus produced by the goblet cells of the conjunctiva initially increases in quantity during inflammation - a large amount of mucous discharge appears. But soon the discharge becomes mucopurulent, and in severe cases - purely purulent. The discharge flows over the edge of the eyelid onto the skin, dries on the eyelashes and glues the eyelids together overnight.
Simultaneously with the discharge, redness of the conjunctiva, transitional folds, and the eyeball appears. The conjunctiva of the eyelids and transitional folds becomes brick-red, swells and becomes cloudy, so that the pattern of the meibomian glands is blurred, and the edematous transitional fold protrudes from under the cartilage. A superficial conjunctival injection often develops on the conjunctiva of the eyeball, most pronounced at the fornix and decreasing toward the cornea. The conjunctiva of the eyeball swells and in severe cases rises around the cornea in a ridge, acquiring a glassy yellow tint. Sometimes the edema is so great that the conjunctiva protrudes from the eye slit and is pinched between the eyelids when they close.
Transfer of discharge from the diseased eye to the healthy one using personal items (handkerchief, towel, pillow, etc.) and hands causes infection of other people with acute conjunctivitis. Acute conjunctivitis, if treatment is started promptly and correctly, is short-lived and without complications. Recovery occurs in 5-6 days. Sometimes, with improper treatment, superficial inflammation of the cornea develops. Point gray infiltrates appear along the limbus line of the cornea. This causes photophobia, lacrimation and blepharism - signs of corneal disease. Later, the infiltrates either resolve without a trace or disintegrate with the formation of small ulcers. Superficial ulcers also heal without a trace. Deeper defects of the cornea, already capturing its stroma, heal with the replacement of the defect with connective tissue and therefore leave behind slight opacities.
Where does it hurt?
What's bothering you?
Diagnosis of conjunctivitis
History and examination usually suggest the diagnosis. However, cultures are recommended in patients with severe symptoms, in immunosuppressed patients, in vulnerable eyes (eg, after corneal transplant, in exophthalmos due to Graves' disease), and after initial therapy has failed.
What do need to examine?
How to examine?
Treatment of conjunctivitis
Even without treatment, simple conjunctivitis usually resolves within 10 to 14 days, so laboratory tests are not usually performed. Before treating conjunctivitis, it is important to clean the eyelids and remove discharge. Until the discharge stops, broad-spectrum antibiotics should be used during the day in the form of drops and before bedtime in the form of ointment.
First of all, it is necessary to remove discharge from the conjunctival cavity by frequent rinsing. For rinsing, it is best to use a 1:5000 solution of potassium permanganate, a 0.02% solution of furacilin, a 2% solution of boric acid. Before rinsing, the eyelids are wiped with a swab soaked in a solution of potassium permanganate, after which they are spread apart with the thumb and forefinger of the left hand, and with the right hand, the conjunctival cavity is washed with a generous stream of potassium permanganate solution from a rubber bulb.
After rinsing, antibiotic solutions (penicillin - 30,000 U in 1 ml of saline, 0.5% ampicillin solution, 0.3% gentamicin solution, 0.5% chloramphenicol solution, bacitracin - 10,000 U in 1 ml) or sulfonamide drugs (20-30% sodium sulfacyl solution), vigabact, fucitamik are instilled into the conjunctival cavity every 2-3 hours; ointments (1% tetranicline, 0.5% levomipetin, 0.5% erythromycin), floxal are placed behind the eyelids at night.
Effective are forced instillation of antibiotics (instillation of drops into the conjunctival cavity every 5-10 minutes for 1 hour and every 3 hours).
In acute cases, eye drops Tobrex, Ocacin, Floxal are prescribed up to 4-6 times a day. In case of edema and severe irritation of the conjunctiva, instillations of antiallergic or anti-inflammatory drops (Alomid, Lecrolin or Naklof, Diklof) are added 2 times a day.
It is necessary to remember about the possibility of an allergic reaction to eye drops, especially to antibiotics. In such cases it is necessary to stop the drug that caused allergic dermatitis and prescribe desensitizing agents (diphenhydramine 0.05 g; dicrazil - 0.025 g; tavegil - 0.001 g: ketotifen - 0.001 g), locally - glucocorticoids (1% hydrocortisone solution, 0.1% dexamethasone solution, 0.3% prednisolone solution).
In case of acute conjunctivitis, you should not bandage or tape the eye, as the bandage creates favorable conditions for the proliferation of bacteria, increasing the risk of developing corneal inflammation.
How to prevent conjunctivitis?
Prevention of acute conjunctivitis consists of observing the rules of personal hygiene by both the patient and his family members, since acute conjunctivitis is very contagious; it is necessary to exclude contact with healthy people and people in dormitories, boarding schools, kindergartens and school classes.
Most infectious conjunctivitis is highly contagious and spreads through the air, objects, and touching the eyes. To avoid transmitting the infection, the physician should wash his or her hands thoroughly and disinfect equipment after examining the patient. The patient should wash his or her hands thoroughly after touching the eyes or nasal discharge, avoid touching the uninfected eye after touching the infected eye, avoid sharing towels or pillows, and avoid swimming in a pool. The eyes should be cleared of discharge and covered with a bandage. Young children diagnosed with conjunctivitis should not attend school to prevent the spread of the disease.