Definition

Bacterial conjunctivitis is an inflammation of the conjunctiva caused by bacterial infection. The incidence is approximately 135 per 10,000 people. It often results from compromised ocular defense mechanisms, such as eye surface abnormalities, tear film issues, or systemic immunosuppression, leading to bacterial infection to conjunctiva. It is commonly referred to as pink eye due to its characteristic redness.

Causes

Several bacteria can cause bacterial conjunctivitis, including:

• Staphylococcus aureus (more common in adults)
• Haemophilus influenzae
• Streptococcus pneumoniae
• Moraxella catarrhalis
• Pseudomonas aeruginosa (in vulnerable populations and those who use contact lenses while swimming)
• Klebsiella pneumoniae
• Proteus mirabilis
• Escherichia coli

Bacterial conjunctivitis can be categorized into acute, hyperacute, and chronic forms based on the symptoms. The bacteria responsible for acute conjunctivitis include Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. An infection caused by H. influenzae is often linked to systemic infections, affecting other parts of the body, such as upper respiratory tract infections (URTIs) and middle ear infections (acute otitis media).

Newborns, or neonates, may develop hyperacute conjunctivitis due to infections acquired from their mother’s birth canal. The bacteria Neisseria gonorrhoeae and Chlamydia trachomatis, which are commonly transmitted through sexual activity, can cause these infections.

Chronic bacterial conjunctivitis refers to infections that persist or last for more than three weeks, with the most frequent culprits being Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, and E. coli. S. aureus, in particular, can colonize the conjunctiva and release exotoxins, leading to inflammation.

Risk Factor

Inadequate hand hygiene, frequently touching the eyes, using tissues or towels previously used by an infected person, and improper contact lens care increase the risk of conjunctivitis. Dry eyes also pose a risk due to reduced tear film protection against irritants and pathogens.

Symptoms

Bacterial conjunctivitis typically presents with the following symptoms:

• Eye redness.
• Sticky eyelids, especially in the morning.
• Foreign body sensation in the eyes.
• Continuous watery eyes.
• Greenish-yellow discharge in the eyelashes.
• Presence of similar symptoms in close family or friends.
• History of cough and runny nose a few days prior.

In acute bacterial conjunctivitis, these symptoms emerge rapidly in one eye, with white, sticky eye discharge. Hyperacute bacterial conjunctivitis, presenting even faster, is characterized by thicker, yellow-green discharge in large amounts, eye tenderness, and painful lumps around the ear. Severe hyperacute conjunctivitis can lead to swollen eyes and corneal ulcers, marked by reduced vision and pain. Chronic conjunctivitis symptoms include widespread redness of the eyes, lumps on the inner eyelid, thick white discharge, and eyelash loss.

Diagnosis

Your doctor will inquire about your symptoms, allergy history, any recent flu episodes, and whether you’ve experienced a decrease in vision. If necessary, they may also take a sample of your eye fluid to identify the specific germ—whether it’s a bacteria, virus, parasite, or fungus—that is responsible for your current condition. Identifying the exact germ is crucial as it will guide the appropriate treatment plan.

The doctor’s questions will cover topics such as the duration of your symptoms, the type and color of eye discharge, the amount of discharge, any pain, whether you experience sensitivity to light, your history with eye medications, and if you wear contact lenses. A thorough eye examination will be conducted to assess corneal involvement, the size of your pupils, and the areas of redness in your eyes. Additionally, your doctor will check for any lumps by gently pressing on your neck, the back of your head, and your ears.

Management

The management of bacterial conjunctivitis often involves regularly irrigating the eyes with sterile warm water to remove debris or foreign objects and wash away any secretions. You can also wear glasses to minimize the risk of rubbing or directly touching your eyes, which can lead to irritation. If advised by your doctor, eye closure should be done with glasses only, as using gauze or bandages can create a breeding ground for pathogens if not kept sterile. To help alleviate pain, your doctor may recommend pain relievers like 500 mg Paracetamol, taken one to four times a day. In cases of bacterial infection, antibiotics are usually prescribed to control the infection, with the treatment potentially adjusted based on bacterial culture results and antibiotic sensitivity.

For conjunctivitis caused by Gonococcus bacteria, the treatment plan typically involves administering antibiotic injections for 3 to 5 days, followed by a 7-day course of oral antibiotics. Additionally, antibiotic eye drops may be prescribed for the first 2 to 3 days.

In cases of chronic conjunctivitis, the treatment focuses on avoiding the underlying causes, such as prolonged exposure to dust, smoke, chemicals, local irritation from trichiasis or foreign objects, or excessive alcohol consumption combined with insomnia and metabolic issues. If necessary, your doctor may prescribe antibiotic eye drops for a 14-day period.

Home Care

To manage conjunctivitis at home, consider the following steps:

• Apply warm compresses to alleviate itching and pain.
• Wash hands before touching the face and eyes.
• With clean hands and a cloth or tissue, clean eye mucus several times a day; wash towels or discard tissues after use.
• Wash pillowcases, cloths, and towels exposed to eye fluid with warm water and detergent.
• Avoid using the same eye drops on unaffected eyes.
• Refrain from touching or rubbing eyes to prevent worsening.
• Temporarily stop using contact lenses until advised by a doctor.
• Regularly clean glasses.

Complications

Complications of bacterial conjunctivitis include corneal infection due to gonococcus, leading to edema, central necrosis, corneal ulceration, and potential perforation.

Prevention

Conjunctivitis can spread through close personal contact, such as touching, shaking hands, or contacting contaminated surfaces followed by touching the eyes. Good personal hygiene is essential to prevent conjunctivitis. Preventive measures include:

• Regularly changing pillowcases.
• Keeping contact lenses clean.
• Diligently washing hands according to the WHO's five steps, especially after activities or contact with infected individuals.
• Avoiding the use of others' towels, tissues, or make-up tools.
• Minimizing eye-touching, particularly with unwashed hands.

When to See a Doctor?

If you exhibit these symptoms, you may have bacterial conjunctivitis, which can spread to those around you. Seeking medical treatment is essential. Avoid self-medicating, as this can lead to more serious eye conditions.

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