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The red eyes in the photo are not so scary – they can only spoil the photo. Red eyes “in real life” can be a dangerous symptom – underestimated seemingly trivial conjunctivitis can permanently damage your eyesight.
It happens that health is guarded by … our vanity. This is the case with conjunctivitis, which doesn’t hurt too much (rather hurts) and doesn’t look very special. Because all makeup for nothing with red eyes. Often, therefore, we mobilize ourselves to visit an ophthalmologist only for this reason. And this is exactly what happened with Danka, who has been wearing contact lenses for years and is used to the fact that her eyes are sometimes red. Usually, however, it would pass by itself, and this time – somehow not. The second day passed, and finally Danka broke and went to an ophthalmologist. The diagnosis surprised her completely: adenoviral keratoconjunctivitis! And that there are no jokes with the cornea – even Danka herself knew that much.
Viral and bacterial infections
Where could Danka catch the virus? Actually everywhere. A short contact with an infected object is enough: wiping someone’s face with a towel or leaning against the headrest on the train. Of course, not every incident like this must immediately result in an infection. The cells of the immune system in the conjunctiva (the mucosa that cover the eyelids on the inside and the eyeball on the outside) can handle infectious material in many cases without us even knowing it. However, if for some reason our immunity is weakened, we have little chance of avoiding the disease – viral conjunctivitis and corneal infections are extremely contagious.
Statistically, bacterial conjunctival and corneal infections are more common than viral ones. They are favored by non-compliance with hygiene rules, e.g. not washing hands, and swimming in the pool without glasses. They often accompany infections of the upper respiratory tract. The mechanism is simple. When we have a swollen nasal mucosa, the outflow of tears in their natural way – through the tear ducts to the nose – is difficult and they accumulate in the conjunctival sac and lead to troublesome tearing. However, by wiping the tears running down the cheeks, we often introduce various types of pathogens directly into the eye, causing conjunctivitis in a short time. It’s often seen in children – some even have conjunctivitis symptoms with any infection.
Mixed-type infections are also common – for example, when bacterial superinfection is added to viral conjunctivitis. Then, in order to prevent such a development, after finding a viral infection, the doctor may also prescribe antibacterial drugs.
The least common conjunctivitis is caused by fungi. Such inflammation is usually the result of trauma or decreased immunity – for example, in people undergoing chronic immunosuppressive therapy. Fungal inflammations most often occur after injuries with organic material – e.g. after hitting a branch or stinging a plant directly in the eye.
Particularly dangerous pathogens
Danka was unlucky because her conjunctiva was attacked by a particularly nasty virus. Adenoviral conjunctivitis and keratitis – as the name suggests – attacks both these tissues at once: the conjunctiva and the cornea – the non-vascular, convex, completely transparent outer layer of the eyeball. In general, in the case of viral conjunctivitis, corneal superinfection occurs much more often than in the case of bacterial infection – it is this infection that poses the greatest danger. The conjunctivitis itself is not so dangerous. However, when a virus or bacterium also attacks the cornea, it can ulcerate, which is a chronic inflammatory process, and this is a very serious matter. Then, even after the ulcer has healed, scars may remain on the cornea and impair vision.
Most bacteria only cause keratitis if it has been mechanically damaged. When we clasp the eye, bump or scratch it, the bacteria penetrate deeply and the infection often covers the entire cornea. However, there are bacteria that penetrate the cornea even when it is not damaged. Unfortunately, such keratitis is quite dangerous, because in addition to incorrect treatment or failure to respond to treatment, the eyeball may become perforated – then a hole is formed in the eye and the ability to see can be lost. These particularly dangerous bacteria include gonorrhea and diphtheria coryneus.
High-risk group
Who if who, but Danka should take into account the possibility of conjunctivitis. As a contact lens wearer, he belongs to one of the high-risk groups. Although the most common cases of conjunctivitis are those wearers of lenses who do not follow the basic rules of hygiene in their care, but the disease is also favored by less hydration of the eye (the lens absorbs moisture from it). For this reason, everyone suffering from dry eye syndrome is at risk – from adolescents who spend many hours in front of the computer (looking at the monitor less often and the eye is not properly moistened), to women in the menopausal period (the change in the composition of tears then causes less hydration of the eyes) ).
Not only the hormonal changes associated with menopause predispose to dry eye syndrome and conjunctivitis, but also diseases of the thyroid gland and other glands. People suffering from immune-related skin diseases are also prone to conjunctivitis. For example, scarring pemphigoid and Stevens-Johnson syndrome often cause this kind of inflammation that can lead to eye-damaging adhesions between the eyelid and the eyeball.
From saline to antibiotic
Danka was lucky. There is no trace of a dangerous illness, and after a few weeks she could start wearing contact lenses again. In general, however, the treatment of viral inflammations is more difficult than bacterial ones, because doctors have much less effective drugs at their disposal. Therefore, such infections are often treated only symptomatically and supplemented with antibacterial prophylaxis to prevent superinfection. There are practically no ready-made antifungal drugs – they have to be made to order.
The situation is completely different in the case of the most common bacterial inflammations. Due to the increasing range of antibiotics that can be used in the drops, such infections disappear much faster today than before. If one drug does not work, a second or even a third drug is used (starting with a drop of a narrow-spectrum antibiotic, then with a broad-spectrum antibiotic). Only when this does not work, the conjunctival sac is cultured (however, not every office is such a possibility) and checks which bacteria caused the inflammation. From this culture, their sensitivity to individual antibiotics is also tested and targeted treatment is already initiated.
Sometimes, however, the culture is not sufficient to make a diagnosis. This is especially true of chronic conjunctivitis caused by chlamydia, a pathogen that enters cells and wreaks havoc on them. Then you need to take scrapings from the mucosa or a section of the conjunctiva. For this procedure, the eye is anesthetized with drops. Often, the cultures also fail in the case of viral infections, because the cultivation of viruses is much more difficult than the cultivation of bacteria.
However, some bacteria become resistant to commonly used antibiotics. Sometimes we contribute to it ourselves, for example, if we stop taking the drug too quickly or we dose it less frequently than recommended by the doctor – then often even changing the antibiotic does not help. The occurrence of antibiotic resistance is also favored by too frequent use of these drugs in situations where there is no need for antibiotic treatment. Therefore, if for some reason, e.g. working conditions, we often have a minor, so-called simple bacterial conjunctivitis, we can try to help ourselves by rinsing the eye regularly with saline, possibly with boiled water (but not often with an allergenic chamomile!). At the pharmacy, you can buy both salt and special containers for this purpose. Systematic removal of the secretions from the conjunctival sac in this way is usually enough to get rid of the problem.
Necessary medical diagnosis
But what if Danka had stopped rinsing the sick eye? Better not to think. That is why it is safest to give the doctor a chance as soon as possible so that he can decide whether our inflammation is dangerous. The absolute indication for an immediate visit to an ophthalmologist is the deterioration of vision – it usually indicates that the cornea has already been attacked. It is not a problem if the deterioration of vision was caused by the presence of purulent or mucopurulent discharge on the cornea accompanying conjunctivitis. In such situations, your eyesight is restored by blinking more frequently or by rinsing your eyes with saline. However, if the cornea is already occupied, rinsing or blinking will not help. Then we should not postpone the visit to the ophthalmologist – even because of a business trip or important matters at home. If we delay asking a specialist for help, we can cause ourselves problems greater than an unsigned contract or a failed family meeting. After all, not everyone is as lucky as Danka …
How to safely remove a foreign body from the eye?
It is easy to contaminate the eye by touching it with a dirty hand or a stale handkerchief – and sometimes you have to remove a foreign body from it. It is best to remove them by rinsing the eye with a saline solution. You can also open the upper eyelid – because most of the foreign bodies are there when blinking – and remove the obstruction with a sterile gauze pad. Only as a last resort, if we have nothing else at hand, we can use a tissue.
What can conjunctivitis be confused with?
Conjunctivitis is manifested by redness of the eye, a feeling of sand under the upper eyelid, possibly (not always) the presence of discharge. If it is white and the eye itches, it is likely that the inflammation has an allergic background. Bacteria are usually accompanied by purulent discharge – yellow or yellow-green, and viruses – watery.
In both conjunctivitis and keratitis, the eye is red, but with conjunctivitis, the vessels are usually more dilated and more visible a few millimeters from the cornea. In keratitis, the inflammation is closer to the cornea (more centrally), and individual vessels are sometimes difficult to distinguish – the eye appears uniformly blue-red.
Conjunctival redness is also one of the symptoms of an attack of glaucoma, but is usually accompanied by severe eye pain, a significant deterioration in visual acuity, sometimes headache, and even nausea and vomiting. The most characteristic, however, is the dilated pupil that does not respond to light.
Text: Dorota Jastrzębowska. Consultation: lek. Krzysztof Wasiak, MD