Bacterial viral infectious conjunctivitis
Your eye becomes red and sticky. It's watering and itchy, as if there's a grain of sand stuck in it… Your eyelid is swollen, and on top of that, you have a cold. Perhaps someone in your family or circle of friends has even recently experienced the same symptoms? Don't panic! As unpleasant as it may be, this discomfort is usually a sign of a perfectly benign condition: simple infectious conjunctivitis. This is a bacterial or viral infection of the surface of the eye. Here is some information about this condition.
The symptoms
The eye is red, even very red. It itches a lot, waters, and is stuck together in the morning, associated with secretions often described as purulent.
There is a sensation of grit and sand, a very significant discomfort, but never any outright pain.
Most often, vision is not impaired. Sometimes, however, slight blurred vision may occur. In principle, there is no glare.
Sometimes, a painful lymph node may appear in front of the ear and confirms the diagnosis. This is called preauricular lymphadenopathy, which is often associated with flu-like symptoms (fever, cough, respiratory irritation).
Why consult a doctor?
Conjunctivitis is a benign condition which, as its name suggests, affects the conjunctiva.
However, it is not uncommon for the disease to also affect the cornea. This is then called "keratoconjunctivitis," which the ophthalmologist can identify during a consultation examination by instilling a drop of fluorescein.
This is a particularly aggressive form, usually caused by an adenovirus (ADV), sometimes treated with high doses of anti-inflammatories to reverse corneal lesions.
During the examination, when administering fluorescein, the ophthalmologist will also ensure that an abscess is eliminated, particularly in contact lens wearers.
He will also need to rule out other differential diagnoses such as herpes (which can sometimes mimic conjunctivitis), uveitis, scleritis, keratitis and all causes of red eye.
Caution: Keep away from children and babies.
Young age is a vulnerable period that requires careful attention. While examining newborns and children is difficult, a brief examination of the cornea using fluorescein is essential to confirm the diagnosis.
In cases of confirmed conjunctivitis, exclusion from school may be recommended.
The causes
Viral conjunctivitis
This is by far the most common infectious conjunctivitis!
The picture is usually bilateral, and often occurs in an epidemic context: a child, a spouse, a colleague may have presented the same symptoms in the days preceding the onset of the disease.
The oropharyngeal sphere and the lungs of the patient can be affected by this viral infection which can then cause a cold, laryngitis, tonsillitis, bronchitis, flu-like symptoms and fever.
The list of viruses that can cause this condition is long (Respiratory Syncytial Virus, adenovirus… and even the chickenpox virus!)
Bacterial conjunctivitis
Other microorganisms can also cause this infection, particularly bacteria, although this is much rarer.
And here, beware of preconceived ideas! The purulent nature of the secretions is not necessarily in favor of this origin and can just as easily be observed in viral conjunctivitis – the severity of the infection being only very relatively correlated with the type of germ we are dealing with.
Many types of bacteria can be involved in bacterial conjunctivitis. In some cases, genuine infections with sexually transmitted germs (Chlamydia trachomatis, Neisseria gonorrhoeae in particular) are even observed.
Course of action
Following the consultation during which the ophthalmologist confirmed the diagnosis, copious eye irrigation will always be prescribed. In addition, the following precaution should be taken:
Prevent the spread
Conjunctivitis is extremely contagious. Even before consulting a doctor, if you experience any suggestive symptoms, you should pay close attention to hygiene to prevent the disease from spreading to those around you.
This involves transmission through contact of virus-laden secretions with human mucous membranes. Hand-to-hand transmission is entirely possible.
It is therefore important to wash your hands regularly, especially after touching your eyes. Contact with young children, and particularly newborns, should be avoided as much as possible.
In a group setting, exclusion may be prescribed.
Prevent the spread
Conjunctivitis is extremely contagious. Even before consulting a doctor, if you experience any suggestive symptoms, you should pay close attention to hygiene to prevent the disease from spreading to those around you.
This involves transmission through contact of virus-laden secretions with human mucous membranes. Hand-to-hand transmission is entirely possible.
It is therefore important to wash your hands regularly, especially after touching your eyes. Contact with young children, and particularly newborns, should be avoided as much as possible.
In a group setting, exclusion may be prescribed.
How to prevent conjunctivitis from spreading?
Viral and bacterial conjunctivitis can spread from person to person. Follow these tips to avoid infecting others or becoming reinfected.
Use a clean towel or tissue each time you wipe your face and eyes.
Wash your hands very often. Always wash them before and after eating, when you go to the toilet, or after sneezing or coughing.
Try not to touch your eyes. If you do, wash your hands immediately.
Bacteria can survive in makeup products. This can cause conjunctivitis and even a dangerous corneal infection. Do not use eye makeup while your eyes are infected.
Replace your makeup if you have an eye infection. And never share eye makeup with other people.
Do not wear your contact lenses if you have conjunctivitis. Change your lenses, case, and cleaning solution when you resume wearing them once you have recovered.
Antibiotics are not automatic
Your ophthalmologist didn't prescribe antibiotics? That's perfectly normal!
As we have seen, conjunctivitis is most often a viral disease, but antibiotics are completely ineffective against viruses.
The prescription of medication will be at the discretion of the doctor, who may sometimes consider prescribing anti-inflammatories to alleviate symptoms.
The role of corticosteroids
If conjunctivitis becomes chronic, the symptoms can last for several weeks or even several months. They are linked to an autoimmune disorder rather than to the pathogen responsible for the initial infection.
In this case, corticosteroid treatment with eye drops may be prescribed (never as a first line of treatment).
This treatment will reduce symptoms very quickly and effectively, but its use should be limited as much as possible because tolerance can develop. Conjunctivitis symptoms return when this treatment is stopped, making withdrawal difficult.
You will be able to discuss the benefit/risk balance of this treatment with the doctor, bearing in mind that the shorter the duration of use will be the best compromise.
Patience and washing accomplish more than strength or rage.
In all cases, patience will be your best ally, as well as abundant eye washes and rinses as recommended and prescribed.
Indeed, as with the flu, viral infections are unfortunately not very amenable to modern treatments.
How long does conjunctivitis last?
Be patient! Conjunctivitis usually clears up with treatment or on its own within one to two weeks. If your symptoms persist longer, you should see your ophthalmologist again. They can make sure you don't have a more serious condition.
Complications – Adenovirus keratoconjunctivitis
There is a type of aggressive conjunctivitis caused by adenovirus. The diagnosis is made retrospectively, when conjunctivitis progresses unfavorably despite standard medical treatment.
The virus infiltrates the cornea (keratitis) and creates fine opacities (infiltrates or nephelia). It also protects itself from external treatments by forming membranes (white films covering the conjunctiva).
Treatment involves removing the membranes under local anesthesia (eye drops) and gradually reducing the dosage of anti-inflammatory medication. A drop of Betadine is sometimes instilled, as it is the only known virucidal agent. The treatment is lengthy but prevents significant vision loss caused by corneal infiltrates.
Frequently Asked Questions
How does one contract viral or bacterial conjunctivitis?
Viral conjunctivitis is usually transmitted by touch. You unknowingly touch an infected surface and then touch your eyes. Some viruses can survive for up to a week on a dry surface! Therefore, the exact cause is rarely identified.
How long does viral conjunctivitis last?
Viral conjunctivitis takes at least one week to clear up. No improvement is expected during the first three days of treatment. The first noticeable improvements usually appear after five to seven days.
How long does bacterial conjunctivitis last?
Bacterial conjunctivitis clears up more quickly than viral conjunctivitis. On average, it takes 3 to 5 days to clear up, compared to 7 to 10 days for viruses.
How to treat and cure viral conjunctivitis?
The treatment of viral conjunctivitis is based on two pillars:
Frequent washing with saline solution – 3 to 5 times a day
Antiseptics (not antibiotics) – Vitabact type
In cases of hyperinflammatory conjunctivitis, with giant papillae, infiltrates on the cornea or false membranes, the introduction of corticosteroid treatment is necessary.
How to treat and cure bacterial conjunctivitis?
The treatment of bacterial conjunctivitis rests on two pillars:
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Abundant rinsing with physiological saline – 3 to 5 times a day, in order to remove the infectious load.
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Antiseptics or antibiotics to accelerate the control of the infection.