PINK-EYE

Pink-eye is the lay term for acute follicular conjunctivitis. This condition occurs in small epidemics and was once known as "dockyard workers conjunctivitis", when it was described amongst workmen during the Second World War.

Acute follicular conjunctivitis is commonly caused by an adenovirus. The key finding is that of follicles, small bumps in the reddened conjunctiva, seen when the lower lid is pulled down, and the palpebral conjunctiva examined. Although this condition is bilateral, the follicles and symptoms are often more prominent on one side.

Acute follicular conjunctivitis follows the so-called "rule of eights", eight day incubation period, eight days maximum symptoms and eight days to resolution. It takes a full month to go away.

The use of topical antibiotics is not indicated if the condition is strictly viral (as indicated by the follicles). Topical antibiotics may often cause a secondary allergic reaction (conjunctivitis medicamentosa) complicating the picture and prolonging the patient's complaints. Presevative free artificial tears (e.g. Refresh) and hot compresses are indicated for symptomatic relief.

The presence of copious amounts of pus is more indicative of a bacterial conjunctivitis This may be treated by broad spectrum antibiotics such as Polytrim (polymixin B sulfate and trimethoprim sulfate), gentamicin 0.3%, and tobramycin 0.3%. These will give good coverage of gram-positive and gram-negative organisms. The aminoglycosides (gentamicin and tobramycin) have weak activity against Staphylococcal species and there are also resistant strains of Pseudomonas. Fluoroquinolones are also good options.

Should the patient's symptoms and the reddness in the eye last more than six weeks, or if the patient develops corneal symptoms he should be refered to an ophthalmologist. The differential diagnosis¹ of chronic follicular conjunctivitis includes atopic conjunctivitis^2,3 and adult inclusion conjunctivitis^4,5 (chlamydia).

- Paul Price

1. Jackson WB. Differentiating conjunctivitis of diverse origins. Surv Ophthalmol. 1993 Jul-Aug;38 Suppl:91-104. Review.
2. Parys W Blockhuys S Janssens M: New trends in the treatment of allergic conjunctivitis. In: Doc Ophthalmol (1992) 82(4):353-60
3. Friedlaender MH. Conjunctivitis of allergic origin: clinical presentation and differential diagnosis. Surv Ophthalmol. 1993 Jul-Aug;38 Suppl:105-14. Review.
4. Dawson CR et al: Chlamydial Keratoconjunctivitis. In: Pepose JS, et al (eds) Ocular Infection and Immunity. Mosby, Boston 1996:818-829.
5. Lampariello DA, Baylus SL: Diagnosing inclusion conjunctivitis. J Am Optom Assoc 1994, 65:827-34.

This page last updated February 28, 1999