Although the monsoon is pleasant, it also brings a host of health issues. Conjunctivitis is one of them. This article explains the difference between bacterial and viral conjunctivitis, its clinical manifestation and its treatment.

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The rainy season can increase your risk of developing eye infections since the increased humidity in the air makes it easier for bacteria, viruses, and other germs to spread and proliferate. Infectious or allergy conditions frequently cause conjunctival inflammation. Usually, it is done alone.

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Clinical characteristics

Clinical characteristics vary depending on the underlying cause, however frequently the eyes feel gritty or irritated due to allergic conjunctivitis

1. Discharge is persistent and may be purulent, mucoid, or watery; normally, the eyelashes are stuck together on awakening; there may be momentary blurring as a result of discharge obscuring the cornea, but this is quickly cleaned by blinking; photophobia and pain indicate corneal involvement, keratoconjunctivitis which is not uncommon; there is diffuse hyperaemia overlaying the sclera and the inner surface of the eyelids.
2. Itching is a sign of an allergic reaction. Topical antibiotics are used to treat infectious conjunctivitis, while anti-inflammatory drugs are used to treat non-infectious conjunctivitis.
3. A meta-analysis found that acute conjunctivitis encountered in primary care may be seen as a self-limiting illness, with the majority of patients improving independent of antibiotic treatment. Antibiotics may be marginally beneficial for patients with purulent discharge or mild red eye.

Bacterial and viral conjunctivitis

Bacterial conjunctivitis may be distinguished from viral conjunctivitis based on the discharge (mucopurulent vs watery), age of the afflicted kid (preschool-aged versus school-aged), and bilaterality of the illness.

Manifestation of viral conjunctivitis

Bacterial conjunctivitis manifestation

Infants, toddlers, and preschool-aged children are most often diagnosed with acute bacterial conjunctivitis. 5 million instances are reported yearly in the United States, with 1 in 8 youngsters experiencing an episode. Bacterial conjunctivitis is a self-limiting condition that, without antibiotic treatment, normally lasts between 7 and 10 days. Bacterial conjunctivitis is distinguished by mucopurulent discharge and eyelid matting.

Common symptoms of acute bacterial conjunctivitis include burning and stinging. Although bacterial conjunctivitis may affect just one eye, it often affects both eyes or spreads to the other eye. Acute bacterial conjunctivitis is often accompanied by a middle ear infection. When a patient has both conjunctivitis and middle ear infection, systemic antibiotics are needed. Similarly to viral conjunctivitis, bacterial conjunctivitis is very infectious.

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Treatment

Treatment of bacterial conjunctivitis

1. In terms of preventative care, regular hand washing and saline irrigation of the conjunctival sac to flush out secretions are two examples of broad, overarching strategies.
2. Antibiotics: Apply an antibiotic drop or ointment with a wide spectrum, such as chloramphenicol ointment used twice daily for five days. If an investigation for the causative agent has been conducted, a particular therapy may be determined.
3. Topical fluoroquinolone antibiotics like ciprofloxacin and ofloxacin are not more effective than chloramphenicol for superficial ocular infections, but they are advised when the patient is sensitive to the former and there is resistance or unpleasant responses to the latter. Moreover, they are relatively costly
4. The ocular fluoroquinolones of the fourth generation (moxifloxacin and gatifloxacin) are more effective against gram-positive bacteria than ciprofloxacin and ofloxacin.
5. Moxifloxacin and gatifloxacin enter ocular tissues more effectively than previous fluoroquinolones. moxifloxacin and gatifloxacin are used to treat conjunctivitis complicated by keratitis.
6. Azithromycin twice daily for three days is useful for the treatment of conjunctivitis caused by purulent bacteria, particularly in youngsters.

Treatment of viral conjunctivitis

1. The majority of instances are self-limiting and resolve in one to two weeks. Eyedrops containing chloramphenicol may be used to prevent subsequent bacterial infection.
2. Hypromellose eye drops may be used as a simple (and calming) eyewash.
3. Steroids are contraindicated for herpetic infection because they exacerbate and considerably extend the condition.
4. Acyclovir is an effective medication for herpes simplex and varicella zoster.
5. Adenoviral conjunctivitis: Prevent close direct and indirect contact for two weeks following the beginning of symptoms. 

Treatment of allergic conjunctivitis

The basic tenets of allergy management are:

1. Avoiding the allergen, if possible;
2. Using a topical antihistamine, rather than an oral one; and topical antihistamines may be useful, oral antihistamines do not have a role.
3. For allergic conjunctivitis, antihistamine eye drops such as antazoline (with xylometazoline as Otrivine-Antistin), azelastine, epinastine, ketotifen, and olopatadine may be administered. It is not a treatment option that is suitable for long-term usage (no longer than six weeks) and is also not a suitable alternative for treating contact dermatoconjunctivitis
4. Oral antihistamines such as loratadine or chlorphenamine may be used o are particularly beneficial when allergic rhinitis is present and might produce drowsiness, particularly the older compounds such as chlorphenamine - patients should be warned about this.
5. Other possible preparations include :

• Sodium cromoglicate (sodium cromoglycate) and nedocromil sodium eye drops - These formulations may be beneficial for vernal keratoconjunctivitis and other allergic types of conjunctivitis.
• Lodoxamide eyedrops may be used to treat allergic conjunctivitis, especially seasonal allergic conjunctivitis.

       6. In general, corticosteroid-containing ointments or drops should be avoided unless the physician can reliably monitor for side effects e.g., glaucoma, cataracts - only used when the diagnosis is certain.

        7. Treatment with oral corticosteroids

• A five-day regimen may be administered in extreme situations if the diagnosis is certain.
• In extreme instances of allergic conjunctivitis, ophthalmologists may utilize oral steroids.

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When should conjunctivitis patients be referred?

The vast majority of conjunctivitis instances do not need investigation or referral. The following conditions need a referral to an ophthalmologist:

• Newborn conjunctivitis
• Chronic conjunctivitis
• If conjunctivitis does not respond to the first therapy (if there is no improvement after 7 to 10 days)
• Conjunctivitis is accompanied by corneal abnormalities.
• Conjunctivitis with visual blurring or pain as opposed to discomfort
• Sicca (i.e. dry eye syndromes)

If conjunctivitis is a sexually transmitted illness, it is imperative to send the patient and contacts to the genitourinary medicine division.

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This is the next article of our monsoon series. To read the earlier articles of the series, click here: Malaria in monsoon: Recent updates; Managing dengue fever: What you should knowLeptospirosis: A commonly misdiagnosed disease; Know cholera: Diagnosis and treatment approach; Chikungunya: An overview of diagnosis and treatment; Typhoid Treatment in OPD: Recent Updates; Treating Skin Infections in Monsoon; Influenza in Monsoon: How to Differentiate Between Flu and Common Cold?; Jaundice In Viral Hepatitis: Symptoms And Management Overview

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.