Conjunctivitis, commonly known as pink eye, is an inflammation of the conjunctiva, the thin, transparent tissue that covers the front surface of the eye and lines the inside of the eyelids. Conjunctivitis can be caused by various factors, including infections, allergies, and irritants, leading to different types of conjunctivitis that require specific management and therapy. Infectious conjunctivitis is often caused by bacteria or viruses. Bacterial conjunctivitis typically presents with redness, discharge, and crusting of the eyelids. It is commonly treated with topical antibiotics to eliminate the bacterial infection. On the other hand, viral conjunctivitis is caused by a viral infection and tends to be self-limiting, with symptoms like redness, watery discharge, and sensitivity to light. Management for viral conjunctivitis involves supportive care, such as cold compresses and lubricating eye drops, to alleviate discomfort while waiting for the infection to resolve. Allergic conjunctivitis occurs when the eyes react to allergens, such as pollen, pet dander, or dust mites. It results in itching, redness, watery discharge, and swollen eyelids. Antihistamine eye drops or oral antihistamines can help relieve symptoms by reducing the allergic response. In some cases, mast cell stabilizers or corticosteroid eye drops may be prescribed to control severe allergic reactions. Other specific types of conjunctivitis include giant papillary conjunctivitis, which is often associated with contact lens use or ocular prosthetics, and vernal conjunctivitis, a chronic allergic condition primarily affecting young people. These types may require a combination of treatments, including avoiding the triggering factors, using lubricating eye drops, and, in severe cases, prescribed medications like mast cell stabilizers or topical steroids. Additionally, conjunctivitis can be caused by exposure to irritating substances, such as chemicals or smoke, leading to chemical conjunctivitis. The primary management for this type involves thoroughly rinsing the eyes with clean water or saline solution to flush out the irritants. In all cases, practicing good hygiene measures, such as frequent hand washing and avoiding touching the eyes, can help prevent the spread of infectious conjunctivitis. It is important to consult an eye care professional for an accurate diagnosis and appropriate management of conjunctivitis. They can provide personalized recommendations and prescribe the most suitable therapy based on the type and severity of the condition, with the goal of relieving symptoms, promoting healing, and preventing complications.

1. CONJUNCTIVITIS
Dr.Navaneethakrishnan PharmD.,
Assistant Professor
Department of Pharmacology

3. INTRODUCTION
 Conjunctivitis is the inflammation of the conjunctiva.
 The conjunctiva is a thin membrane that covers the inner
surface of the eyelid and the white part of the eyeball
(sclera).
 Inflammation of the conjunctiva is called conjunctivitis,
which makes the white of the eye appear to red.
 When small blood vessels in the conjunctiva become
inflamed, they’re more visible. This is what causes the
white of the eyes to appear reddish or pink. It is also

4. Conjunctivitis - Inflammation of the
conjunctiva

5. Risk factors
 Exposure to something for which the person have an allergy
(allergic conjunctivitis).
 Exposure to someone infected with the viral or bacterial form
of conjunctivitis.
 Using contact lenses frequently.
 Microbial infection (chlamydia, fungus, etc.,).

6. Causes
 Viral conjunctivitis : Adenovirus, HSV.
 Bacterial conjunctivitis : Staphylococcus aureus,
Staphylococcus pneumoniae, Haemophilus influenza,
Chlamydia trachomatis.
 Allergic conjunctivitis : Pollen, perfumes, cosmetics, smoke,
dust.
 Chemical conjunctivitis : Acid or alkali’s.

7. Types of Conjunctivitis
Viral and Bacterial conjunctivitis :
 Viral and Bacterial conjunctivitis may affect one or both eyes.
 Viral conjunctivitis usually produces a watery discharge.
Bacterial conjunctivitis often produces a thicker yellow-green
discharge.
 Both Viral and Bacterial conjunctivitis can be associated with
colds or with symptoms of a respiratory infection, such as a
sore throat.

8. Types of Conjunctivitis
Viral Conjunctivitis Bacterial Conjunctivitis

9. Viral and Bacterial Conjunctivitis
 Both viral and Bacterial conjunctivitis are very contagious.
They are spread through direct or indirect contact with the eye
secretions of someone who’s infected.
 Adults and children alike can develop both of these types of
pink eye. However, bacterial conjunctivitis is more common in
children than it is in adults.

10. Allergic Conjunctivitis
 Allergic conjunctivitis affects both eyes and is a response to an
allergy causing substance such as pollen.
 Most allergic conjunctivitis can be controlled with allergy eye
drops.

11. Toxic Conjunctivitis (Chemosis)
 Toxic conjunctivitis typically occurs with constant use of
topical ocular medications.
 The reaction may take days to years to develop. There
also appears to be a dose response effect with regard to
the preservative concentration and total amount of
preservative containing medications used.
 It implies direct damage to ocular tissues from an
offending agent, usually a preservative or medication.

12. Conjunctivitis - Pathophysiology
Microbes enter into the eye on contact with infected objects
Inflammation of the eye
Dilation of the blood vessels in eye
Swelling, Redness, exudates and discharge

13. Signs and Symptoms
 Tenderness of the eye, pain, Swelling, Itchiness, Body aches,
Photophobia, Fever, Sore throat, Runny nose.
 Redness of the eye or inner eyelids (hyperemia).
 Discharge and tear (epiphora).
 Drooping of upper eyelid.
Infection usually begins with one eye, but can quickly spread to
other eye in cases of viral or bacterial conjunctivitis.

14. Diagnostic tests
 History collection
 Physical examination
 Culture of secretions
 Conjunctival incisional biopsy.
 Conjunctival scrapes for cytology (rarely
done) – detecting chlamydia and fungal
infections.

15. Treatment
 The management of conjunctivitis depends on the type.
Most types of mild and viral conjunctivitis are self-
limiting, benign conditions that may not require
treatment and laboratory procedures.

16. Bacterial conjunctivitis
 If the infection is bacterial, the doctor may prescribe
antibiotic eye drops as pink eye treatment, and the infection
should go away within several days.
 Antibiotic eye ointment, in place of eye drops, is sometimes
prescribed for treating bacterial pink eye in children.
 An ointment is often easier to administer to an infant or
young child than are eye drops, though the ointment may
blur vision for up to 20 minutes after application.

17. Bacterial conjunctivitis
 With either form of medication, expect signs and symptoms
to start getting better in a few days.
 Topical antibiotics
 Fluoroquinolones, sodium sulfacetamide or trimethoprim for
7 to 10 days.

18. Viral conjunctivitis
 There is no treatment for most cases of viral conjunctivitis.
Instead, the virus need time to run its course – up to two or
three weeks.
 Viral conjunctivitis often begins in one eye and then infects
the other eye within a few days. The signs and symptoms
should gradually clear on their own.
 Antiviral medications may be an option if the doctor
determines that the viral conjunctivitis is caused by the
Herpes Simplex Virus (HSV).

19. Allergic conjunctivitis
 If the irritation is allergic conjunctivitis, the doctor may
prescribe on of many different types of eye drops for people
with allergies.
 These may include medications that help control allergic
reactions, such as antihistamines or drugs that help control
inflammation, such as steroids and anti inflammatory drops.
 The patient may also reduce the severity of allergic
conjunctivitis symptoms by avoiding whatever causes the
allergies when possible.

20. According to Indian Standard Treatment Guidelines
Ophthalmology
Type Management
Viral conjunctivitis
 Advice the patient to clean the eye by washing with
normal saline frequently.
 Cold compression.
 Topical anti-histaminics
 Frequent application of preservative free artificial
tears.
 Topical antibiotics in cases of suspected secondary
bacterial infection.
 Severe inflammation, presence of sub-epithelial
infiltrate, presence of membranes and pseudo
membranes may necessitate a short course of topical
steroids.
 Herpetic conjunctivitis to be treated with topical

21. Type Management
Bacterial conjunctivitis
 Chloramphenicol 0.5%eye drops
 Ciprofloxacin 0.3%eye drops Intensive instillation
every 15 to 30 min until symptoms and signs are
reduced and gradually tapered.
Allergic conjunctivitis
 Cold compression and ocular lubricants.
 Topical and systemic anti-histaminics.
 Topical mast-stabilizer
 Topical NSAIDs
 Topical steroids in short pulses
Chemical conjunctivitis
 Stop instilling the substances that has caused the
reaction.
 Lubricant ointment can be soothening.
 Mild topical antibiotics like chloramphenicol will
prevent secondary bacterial infection.

22. Type Management
Chlamydial
conjunctiviti
s
In Neonates
 Topical tetracycline1% or erythromycin ointment twice daily for
2 months. Oral tetracycline1.5-2gm daily in divided doses for 2
weeks or oral azithromycin single dose or erythromycin50mg/kg
in four divided doses for 2weeks
In Adults
 Oral azithromycin 1g single dose or doxycycline100mgBD for 7
days or tetracycline250mgqid for 7days or erythromycin 500mg
qid for 7 days.
Gonococcal
conjunctiviti
s
In Neonates
 I M Ceftriaxone 25-50mg/kg single dose
In Adults
 I M Ceftriaxone 1g single dose. I M Spectinomycin 2g single dose.
 Chloramphenicol 1%eye ointment
 Use normal saline or cooled boiled water. Initially continuous
irrigation will be needed.

23. Lifestyle modifications
 Apply a hot compress to the eyes.
 Stop wearing contact lenses.
 Reduce exposure to light.
 Prevent rubbing of the eye.
 Clean the eye using sterile water and cotton swabs, from
inner canthus to outer canthus.
 Use of dark sunglasses is advised, in presence of
photophobia.

24. Prevention
 Don’t touch your eyes with your hands.
 Wash your hands often.
 Use a clean towel and wash cloth daily.
 Don’t share towels or washcloths.
 Change your pillow cases often.
 Don’t use eye cosmetics.
 Don’t share eye cosmetics or personal eye care items.

25. Thank you 