Red eyes, whether in children or adults, are one of the most common reasons for a visit to the therapeutically-endorsed optometrist.

The usual culprit? Conjunctivitis. But this disease has many forms, most of which are mild, short-term and self-limiting – which means it gets better all by itself.

Conjunctivitis literally means inflammation of the conjunctiva – or surface of the eyeball and inner eyelids.  Symptoms include red eyes (especially the inside of the lower eyelid), a watery or sticky discharge, itch and irritation.

There are many causes of conjunctivitis. It can be bacterial (when it often presents with an ear injection) but more commonly it is viral (when it is often associated with a sore throat).  Both of these are infective forms of conjunctivitis and while they are generally short-lived and harmless, they are highly contagious.

Antibiotics and conjunctivitis

While most ophthalmologists and optometrists avoid prescribing antibiotics for conjunctivitis, it is still common practice for GPs to issue a script for Chlorsig or another broad-spectrum antibiotic.

Does this help? If you or your child definitely has bacterial conjunctivitis (and this can only really be determined by culturing the bacteria from a swab in a microbiology lab) then antibiotics may speed up the recovery – but not much!  Studies have shown that the disease resolves on its own within 5 days (on average), while it takes 4-and-a-half days to resolve if antibiotics are prescribed. Not a lot of upside there (and considerable downside if you are trying to instill drops into the eyes of young children).

Causes of conjunctivitis

The causes of most forms of conjunctivitis are viruses (such as adenovirus) and common bacteria (such as staphylococcus), which are found on the skin and around the eyelid margins.  Regular, thorough hand-washing helps to stop the spread of conjunctivitis but this is easier in adults. Children are known to scratch their backside, pick their nose and rub their eyes – in that order!

Occasionally, conjunctivitis can be more serious, so if your symptoms have not improved by one week or completely resolved by two weeks, it is important to see an optometrist.  Serious infective causes include Gonorrhea in newborn babies, or it can be secondary to Herpes (Herpes Simplex or Herpes Zoster Virus) in any age group.

Is it always infectious?

Conjunctivitis can commonly be caused by non-infective causes such as allergy, dry eye disease or other coexisting eye diseases or systemic conditions.  Once properly diagnosed, allergic conjunctivitis can be very effectively managed with anti-allergic eyedrops used once a day in most cases.

Dry eye disease is a multifactorial disease, which requires complex management to relieve signs and symptoms – including conjunctivitis.

Who should I see if I have conjunctivitis?

Optometrists have the equipment to properly inspect your eyes and, provided they are therapeutically endorsed, can provide a prescription for eye drops if required or make the appropriate referral to an ophthalmologist if necessary.

How can I improve my symptoms?

While antibiotics may not be appropriate in many forms of conjunctivitis, there are things you can do to relieve symptoms such as

  • Use chilled unit-dose artificial tears (e.g. Systane) every 1-2 hours
  • Use a cold compress to relieve redness and inflammation
  • Ensure eyelid margins are scrupulously clean using a propriety product such as Blephadex or LidCare available from your optometrist or pharmacy.