Dr. Noah Klein

Noah Klein, MD, PC

August 4, 2009

Red eyes with itching, tearing, clear discharge and a foreign body sensation (feeling of something in the eye) can be caused by a virus. This is called viral conjunctivitis or “pink eye” and can be quite uncomfortable.It may be difficult to differentiate between a viral conjunctivitis and an allergic conjunctivitis. Here are some tips.

Viral conjunctivitis is likely if:

1. The patient recently had an upper respiratory infection (URI), a cold. If so then most likely the same virus has caused the conjunctivitis.
2. There is a tender pre-auricular lymph node on the same side as the conjunctivitis.  If yes then a virus is the likely cause. This lymph node is just in front of the tragus of the ear. The tragus is the bump before the external auditory canal (the ear opening).
3. The pink eye started in one eye and then went to the other eye, but in a milder form. This is characteristic of viral conjunctivitis.
4. The patient had contact at work or home with someone who has a pink eye. If so then the viral infection which is very contagious has spread from that other person.

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Allergic conjunctivitis is likely if:

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• The patient has a history of allergy and it is now allergy season.
• Symptoms are relieved by anti-histamine drops or pills.
• Aside from itching and red eye none of the above criteria exist.

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Treatment

Unfortunately, aside from relieving symptoms, there is no treatment for viral conjunctivitis. It should resolve in 7-10 days just like the common cold. Antibiotic drops do not cure a viral conjunctivitis and nothing but good hygiene can prevent it from spreading to others. Lubricating eye drops and cool compresses help the symptoms.

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Most of the time the condition resolves with no permanent effects. Rarely, a few weeks after the infection is gone the patient experiences photophobia (light sensitivity), foreign body sensation and possible blurred vision. Corneal infiltrates cause this and the patient must be evaluated by an ophthalmologist right away. These may require treatment.

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One of the most frequent “emergency” visits in my office is due to a conjunctival hemorrhage. This is what it looks like:

Conjunctival Hemorrhage

Conjunctival Hemorrhage

Conjunctival Hemorrhage

Although this looks dramatic and scary it is quite harmless most of the time especially if not accompanied by any discomfort and without a history of trauma to the eye.

Some possible associations are anti-coagulant therapy such as warfarin, Plavix or even aspirin. Vomiting and coughing can cause this too.     Why does it happen? The causal event is blood leaking out of a small blood vessel under the conjunctiva. You can think of it as a bruise.

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If you got a bruise anywhere in your body you probably would not pay much attention to it.    However, because the red blood is outlined by the white of the eye it is very noticeable.    Often it is not the patient but a friend or relative that first notices it. Another reason it is so dramatic is that the space between the conjunctiva and the white of the eye, the sclera, is so small that a tiny drop of blood is spread over a large area and appears larger than it truly is.    It usually takes about a week for this to resolve. While resolving it can actually spread and appear as if it it getting larger. It can look yellow as it is being resorbed.<!–adsensestart–>

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