Bacterial Conjunctivitis

Bacterial conjunctivitis is one of the common forms of pink eye and is caused by bacteria which infect the eye through one of several sources of contamination. These bacteria spread via coming in contact with a person who is infected, being exposed to a contaminated surface, or other methods such as ear or sinus infections.

What Are the Symptoms of Bacterial Conjunctivitis?

The symptoms of bacterial conjunctivitis will vary slightly from person to person, but typically include:

  • Redness
  • Crusting of the eyelids (they will frequently be stuck together upon waking up, requiring bathing to open)
  • Thick discharge or pus (which can temporarily blur the vision)
  • Discomfort, typically grittiness or burning

In most cases, bacterial conjunctivitis will be bilateral, but it is possible for one eye to become infected a day or two before the other. This condition is contagious and spread via indirect or direct contact with an infected person’s eye secretions. Although it is more common among children, this condition can affect patients of all ages.

What Causes Bacterial Conjunctivitis?

There are multiple potential causes of bacterial conjunctivitis, but it always involves contracting the bacteria from some outside source. Here are some potential causes:

  • Contamination of the eye’s conjunctival surface
  • Wearing contact lenses
  • Superficial trauma
  • A secondary infection to viral conjunctivitis
  • Recent upper respiratory tract infection, sinusitis, or cold
  • Diabetes or other diseases which compromise the immune system
  • Systemic or topical steroids (which compromise the ocular area’s resistance to infection)
  • Blepharitis or other types of chronic ocular inflammation

Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae are the most common bacteria types that lead to bacterial conjunctivitis.

Types of Bacterial Conjunctivitis

Bacterial conjunctivitis is considered to be highly contagious and contaminated fingers are the most common way that it is spread. It will be classified as hyperacute, acute or chronic, depending on the severity and duration of symptoms.

  • Hyperacute bacterial conjunctivitis

This severe version of conjunctivitis will occur suddenly and develop rapidly. It frequently includes a great deal of yellow-green discharge that returns after being wiped away. Among sexually active adults, it is most commonly due to Neisseria gonorrhoeae. If it isn’t treated by an eye doctor soon, it can lead to loss of vision.

  • Acute bacterial conjunctivitis

This is the most common type of bacterial conjunctivitis for those in primary care. The symptoms will last fewer than three or four weeks. Acute bacterial conjunctivitis is typically due to Staphylococcus aureus in adults and Haemophilus influenzae or Streptococcus pneumoniae in children.

  • Chronic bacterial conjunctivitis

This type will frequently develop along with blepharitis or another inflammatory condition which promotes bacterial growth in the eyelids. It may also include warmth and flaky debris along the eyelid. Symptoms will last for a minimum of four weeks and include frequent episodes. If you have this condition, you should visit your eye doctor.

How to Diagnose Bacterial Conjunctivitis

Most healthcare providers, including doctors and nurses, can diagnose bacterial conjunctivitis based on patient history and symptoms. They know, for example, that conjunctivitis is possibly due to bacterium if the eye discharge is thick as opposed to watery or it occurs when you have an ear infection. In some cases, your doctor may get a sample of the eye discharge from your conjunctiva to conduct a laboratory analysis and tell which type of infection is present and determine the ideal treatment.

It can sometimes be challenging to tell bacterial and viral conjunctivitis apart. The best way to tell the difference is via viral and/or bacterial cultures, but they will not be 100% sensitive and viral conjunctivitis may have a bacterial superinfection. Doctors can also identify adenovirus strains that may cause the infection with an RPS Adenodetector.

How Is Bacterial Conjunctivitis Treated?

About 65% of patients will notice improvement in between two and five days without receiving antibiotic treatment, making bacterial conjunctivitis self-limiting. It is also rare to experience severe complications.

To get rid of the bacteria, you will have to take antibiotics. As such, most of the time, the treatment will involve using topical antibiotic eye ointments or drops. People with bacterial pinkeye can typically go back to school or work 24 hours following the start of antibiotics, provided they have noticed an improvement in symptoms. Viral pinkeye is contagious for as long as the symptoms persist so you should always check with your doctor.

Some patients prefer to delay antibiotic therapy in cases of acute bacterial conjunctivitis. This is due to the risk of an increase in antibiotic resistance as well as the dislike of medicalization for minor illnesses and the extra cost.

What You Can Do to Get Relief

Whether or not you are on antibiotics, you can treat the conjunctivitis by applying a compress to the eyes. Make sure the cloth is lint-free and apply the cloth on your eyelids while they are closed for several minutes a few times daily. Most people find the most relief from cool compresses, but some prefer a warm compress.

If your pink eye is only affecting one eye, don’t touch both of the eyes using the same cloth as this will increase your risk of spreading an infection between eyes. You may also find relief from over-the-counter eye drops known as artificial tears. Some also contain medications like antihistamines which can help those who have allergic conjunctivitis.

How to Prevent Spreading the Infection

Since bacterial conjunctivitis is highly contagious, it is important to take steps to prevent its spread.

  • Don’t rub or touch your infected eye.
  • Frequently wash your hands using warm water and soap.
  • Wash discharge from the eyes at least twice a day. Always use a fresh paper towel or cotton ball and toss it afterwards, washing your hands.
  • Wash towels, pillowcases, and bed linens in hot water with detergent.
  • Avoid eye makeup and never share eye makeup.
  • Don’t wear someone else’s contacts.
  • Wear your glasses instead of contacts. Clean eyewear cases and extended wear lenses and throw out disposable lenses.
  • Don’t share common articles like unwashed glasses, cups, and towels.
  • If applying an ointment or drops to your child’s eyes, wash your hands afterwards.
  • Never use eye drops designed for infected eyes on those that aren’t infected.
  • Stay home from work or school until you aren’t contagious.
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