There are three main types of conjunctivitis you are likely to encounter in practice Signs Symptoms Conjunctival redness Yellow or greenish sticky discharge Grittiness foreign body sensation Bilateral Possible slight reduction in vision caused by tearing and discharge Causes A range of bacteria can be the cause including Staphylococcus species Streptococcus pneumoniae Haemophilus species Moraxella catarrhalis Treatment Bacterial conjunctivitis is normally self-limiting worsening in the first 7 days and then gradually improving Good lid hygiene regular bathing of lids in warm boiled water Cooling compresses will help alleviate symptoms No sharing of bath towels etc Antibiotics are thought to only lead to a mild improvement in the symptoms and shorten the length of the infection by a matter of days If symptoms persist then a dispensing optician can instigate the sale of chloramphenicol 05 drops or 1 ointment for the treatment of bacterial conjunctivitis only- please see ABDO A G After the infection has cleared it is not unusual for mild redness and dry eye to continue for some time- the use of dry eye treatments is recommended Cease contact lens wear and discard previous contact lens and case if used Red Flags Drop in vision More severe photophobia Pain Severe headaches particularly with nausea Corneal opacities Increasing limbal redness Viral Conjunctivitis Signs Symptoms Pink red eye Clear discharge Often patients will report recent cold flu symptoms Dry itchy eye Mild photophobia Foreign body sensation Causes Most commonly associated with adenoviral viruses although rubella measles and herpes simplex viruses are linked Usual cause is association with another person who has the virus Picture shows the classic redness apparent in conjunctivitis and on looking underneath the lid we can see inflammation and signs of a watery discharge Treatment There is no treatment for this condition and patients should be advised that antibiotic drops ointments will not help Cold compresses will alleviate symptoms Dry eye drops are appropriate Viral conjunctivitis is self-limiting so it is more about managing the symptoms Cease contact lens wear Highly infectious- infection control procedures must be put in place by the patient such as no towel sharing etc Red Flags Epidemic keratoconjunctivitis is where there is corneal involvement in the adenoviral infection The patient would be photophobic and vision would be reduced Pain Reduced Vision Increasing red eye Rash on the forehead can be a sign of herpes zoster Allergic Signs Symptoms Usually unilateral Puffy eyes Mild pink eyes Can be seasonal irrational or perennial Mild watery discharge may be present Burning sensation Slight dry eyes although patient will probably repost watery eyes Lid and conjunctiva swelling Itchiness In acute onset px may report sudden swelling of eyelids- this is usually in response to direct contact with the allergen eg mascara eyelash glue etc Can be contact lens related or contact lens cleaning solution related Sub conjunctival haemorrhage are often associated with allergic conjunctivitis due to excessive rubbing of itchy eyes Causes Seasonal Allergic Conjunctivitis SAC is linked commonly to pollens Perennial Allergic Conjunctivitis is more likely to be link to environment household dust household cleaning products pets make up eye products etc Often unknown particularly in acute onset Raised papillae under upper lids which causes symptoms of itchiness and a clear discharge in allergic conjunctivitis The raised areas are inflamed mast cells which produce histamines Picture shows mild pink eye and visible on the temporal side is a swollen and raised conjunctiva- this is conjunctival chemosis Treatment Removal of the allergen where possible Anti-inflammatory eye drops- sodium cromoglicate lodoxamide mast cell stabilizers Cold compresses to alleviate symptoms Lubricating eye drops Sun spectacles for mild photophobia and also may give limited protection from allergen Use of indoor air purifiers Red Flags Preseptal or orbital cellulitis Pain Contact lens wear Reduced vision Increasing Photophobia Atopic keratoconjunctivitis with corneal involvement