Conjunctivitis and Blocked Tear Ducts

There are a number of forms of conjunctivitis including infectious (viral and bacterial), allergic and chemical. The most common form of conjunctivitis in infectious. The conjunctiva is a thin tissue that is composed of many blood vessels and covers the white of the eye. When there is an infection in the conjunctiva, the blood vessels dilate and the eye appears red. In addition, there is often a discharge that can be pustular or watery.

Bacteria usually cause a pustular discharge while viruses often cause a watery discharge. These infections tend to be very contagious. In order to prevent spread of the infection, both antibiotics, as well as meticulous hygiene is important. One should wash ones hands after placing the antibiotic in the eye of the child, or after any touching of the eye, and there should be a special towel set aside for the person who has conjunctivitis.

The only viral infection that requires special consideration is infection with herpes virus. Only an eye doctor who sends special cultures makes diagnosis. Herpes virus can damage the cornea of the eye and cause chronic scarring and subsequent vision defects. Steroid drops will worsen the infection and therefore it is essential that only an ophthalmologist will make the diagnosis and give treatment.

Allergic conjunctivitis is usually seasonal, appearing often on children with a tendency to sneezing, rashes and a runny nose. The most common form of allergic conjunctivitis is “hay fever” which arises from sensitivity to flowers, pollen, and grasses. Despite it’s name, it tends to be more common in the summer. It is manifested by irritated and itchy eyes. Like any allergy, the mainstay of treatment is with antihistamine drops and avoidance of exposure to the offending allergen. Treatment is important in order to decrease complications and improve the quality of life. With time, usually the allergy will decrease, and with adolescence it will disappear. Occasionally, allergic conjunctivitis will occur in the 3rd or 4th decade of life.

Newborn Eye Infections (Ophthalmia Neonatorum)

Any eye infection that occurs in the first month of life is considered a newborn eye infection. The conjunctivas of newborns are particular sensitive to irritation and infection. In the past, the most common reason for infection was a bacterial infection from the time of delivery. A baby going through the birth canal is exposed to many bacteria, some of which can be quite damaging. At the time of delivery the eyes of the baby are closed with the eyelids protecting conjunctiva but if there was early rupture of membranes, or a drawn out delivery, then the baby’s eyes would have been exposed to various bacteria.
In addition, various sexually transmitted diseases can cause sever damage to a newborns eyes. In the last 100 years, antibiotic drops and ointment have been used in all newborns and the incidence of severe eye infections has dropped significantly to 0.06%.

Chemical Conjunctivitis

Disinfecting materials, smoke and various chemicals, will cause redness and burning of the eyes. For example, chlorine is added to pools as a disinfectant. Chlorine, which is meant to prevent infection, will also irritate the conjunctiva, and therefore, someone who swims and leaves his or her eyes open, will suffer from conjunctival irritation. Treatment for chemical conjunctivitis involves cleansing the eye with a sterile cotton ball soaked in salt water, or by using a special eye wife, and by drops against irritation.

Blocked tear ducts

The purpose of tears is to clean the cornea and conjunctiva and to protect them. On each upper eyelid there is produced tears in order to allow the cornea to not get dry. The tears drain towards the tear duct, which is located in the inner aspect of the eye. The tear duct begins to function in the later weeks of fetal development. The reasons that blocked tear ducts are so common is that they tend to get blocked easily due to the malfunction of the small valve in the tear duct. About 5% of babies will have a blocked tear duct at some point in their early life. As a result of a blocked tear duct, there will be excess tears or drainage.

Usually the blocked duct will open on its own before the age of six months. After age 12 months, the likelihood of this happening is small. Therefore the recommendation before age 12 months is to a gentle massage of the area between the inner eye and the nasal bridge for a few minutes, a few times per day and to give antibiotic drops if there a yellowish discharge.

If the discharge continues after 12 months, then usually the opthomologist will have to probe the tear duct (only local anesthesia). This procedure has a 80-90% success rate. If the discharge continues then a silicon tube is placed in the tear duct for three months. If the discharge still continues, then surgical opening of the duct is indicated.

To conclude: a baby under a year of age should see a doctor for any redness or discharge from the eye. In older children, if there is no redness, swelling, pain or discomfort, it is possible to clean to the eye with sterile cotton balls soaked with salt water, or with special eye pads. If there is no improvement in 48 hours, then a doctor should be seen.

About the author: Dr. Efraim Rosenbaum