Bacterial conjunctivitis: how to manage this very contagious disease

By Cristiano Antonino On Mar 24, 2023

Bacterial conjunctivitis is one of the most widespread and common types of conjunctivitis. It is caused by contact with affected individuals, or by an abnormal proliferation of the conjunctival bacterial flora or by pathogenic bacteria from the nasopharynx, the eyelid margin or by the use of contact lenses or foreign bodies

What is bacterial conjunctivitis

This common condition affects the conjunctiva, i.e. the thin mucous membrane that covers the posterior palpebral surface and the anterior part of the eyeball and is generally easy to resolve and self-limiting.

However, its symptoms should not be underestimated and it is necessary to diagnose it promptly to make sure that it is not the sign of a more serious systemic pathology.

This infection has an incubation period of 2-3 days before the first symptoms appear and is often caused by Staphylococci, Streptococci and Pneumococci.

The subject with this infection has abundant purulent secretion, conjunctival hyperemia and swelling (chemosis), eyelid edema.

The eye then appears red.

Bacterial conjunctivitis is very contagious, so the patient must pay attention to his personal hygiene to avoid transmitting it to others.

Bacterial conjunctivitis can be treated with topical therapy based on antibiotic eye drops, possibly accompanied by the intake of corticosteroid drugs with a powerful anti-inflammatory action but only on medical advice.

Bacterial conjunctivitis usually lasts a few days, in fact the symptoms subside in 7-10 days.

The symptoms of bacterial conjunctivitis are particularly bothersome

They include precise signals that appear above all upon awakening from the night:

redness of the eyes (called “eye hyperaemia”)
photophobia (an increased sensitivity to light)
abnormal tearing
swollen eyelids

These symptoms are actually shared by all forms of conjunctivitis and therefore it may be difficult to immediately identify the precise type of bacterial conjunctivitis.

However, during the first check-up visit, the doctor can distinguish clear symptoms that are specific and characteristic of an infection of this type: in detail, bacterial conjunctivitis can be recognized by observing the lacrimal secretion which is abundant and purulent and takes on a yellowish hue, sometimes greenish, with the sensation, especially on awakening from sleep, of feeling the eyelids “stuck together”.

Bacterial conjunctivitis usually does not involve itching sensation or at least not very intensely and typically occurs on only one eye, unlike allergic conjunctivitis which instead involves very annoying itching and is bilateral.

If you’re not careful, though, the infection could spread to your other eye within a few days.

Causes

In adults, bacterial inflammation of the conjunctiva is most often caused by different bacteria, namely Staphylococcus spp., Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis or, less frequently, by Chlamydia trachomatis, a typical neonatal conjunctival infection.

In children, however, bacterial conjunctivitis is mainly caused by H. influenzae, S. pneumoniae and M. catarrhalis or results from a gonococcal infection and/or maternal chlamydia.

Neonatal conjunctivitis occurs in 20 to 40% of newborns born through an infected birth canal.

Hyperacute bacterial conjunctivitis is often caused by the action of a specific bacterium called Neisseria gonorrhoeae, which is the causative agent of gonorrhea: it typically spreads in sexually active adults but can also be contracted by newborns at birth.

The infection occurs suddenly and can rapidly lead to severe ocular involvement with corneal infiltrates and ulcers up to and including perforation of the cornea.

It is characterized by an abundant purulent secretion that quickly reforms even after it has been removed and the patient complains of pain, decreased vision and swelling in the eye area.

Chronic bacterial conjunctivitis is caused by Staphylococcus aureus, Moraxella lacunata and enteric bacteria and is characterized by signs and symptoms that continue for at least four weeks, with frequent relapses.

Diagnosis

The diagnosis of bacterial conjunctivitis is not immediate, even if it is conceivable that the subject suffers from it on the basis of the symptoms he presents.

For a more precise evaluation, the doctor may request tests that can exclude different forms of conjunctivitis (for example the viral one) or other pathologies that can sometimes have similar symptoms such as uveitis, glaucoma, keratitis or eye trauma.

However, we start with a visit to the ophthalmologist: during the anamnesis, in fact, the professional evaluates, in addition to the clinical history, the visible symptoms and those reported by the patient, the degree of redness of the eyes and that of eyelid swelling.

In selected cases and if it is useful for specific therapy, a cytological investigation of the conjunctival secretion can be used.

Conjunctival smears and swabs should be examined microscopically and stained with Gram stain to identify bacteria and Giemsa stain to identify basophilic cytoplasmic inclusion bodies in epithelial cells, characteristic of conjunctivitis caused by chlamydia.

Some people are more prone to bacterial conjunctivitis. Risk factors include:

frequent contact with infected individuals
use of contact lenses
sinusitis
venereal disease (infants born to infected mothers can develop bacterial conjunctivitis immediately after birth)
AIDS (acquired immunodeficiency syndrome)
Other risk factors may be poor tear production, past traumas and conditions of immunosuppression: these situations, in fact, increase the probability of incurring bacterial conjunctivitis.

Complications can occur when the disease spreads to the cornea, an eventuality that is quite frequent when bacterial conjunctivitis, especially if caused by chlamydia or gonorrhea, is not adequately treated.

In rare cases, sepsis (or septicemia) and meningitis that can follow the conjunctivitis supported by N. gonorrhoeae constitute a very serious evolution of the pathology.

Finally, untreated chlamydial conjunctivitis in infants can lead to otitis media or pneumonia.

Interventions and therapies

Bacterial conjunctivitis is usually treated with special eye drops or ophthalmic ointments to be applied directly into the eye.

As a rule, unless the responsible bacterium has been clearly identified following in-depth examinations, broad-spectrum antibiotic drugs are used, which are therefore active on multiple bacteria.

Among the active ingredients used in the treatment of bacterial conjunctivitis are gentamicin, tobramycin, neomycin, erythromycin, ciprofloxacin, ofloxacin, chloramphenicol, etc.

If the doctor does not suspect either a gonococcal infection or chlamydia, he applies empirical therapy with drops of a fluoroquinolone 3-4 times a day for 7-10 days, or chloramphenicol.

In cases of non-response to treatment and if the presence of a resistant bacterium, virus or allergy is suspected, culture and sensitivity tests may be prescribed and performed subsequently so that the results can guide subsequent treatment.

In fact, when the germ is isolated, the doctor prescribes a specific type of eye drops on the basis of an antibiogram which highlights the sensitivity of the pathogen to a specific antibiotic.

Neonatal ophthalmia is prevented instead with the constant use of silver nitrate eye drops or erythromycin-based ointments at the time of delivery.

Natural remedies

In addition to the use of medicines, there are some natural remedies that can help relieve the discomfort of bacterial conjunctivitis, in addition to eyelid hygiene and the hot-moist compresses or chamomile tea mentioned above.

Some substances deriving from medicinal herbs in fact have a soothing activity and reduce the symptoms related to conjunctivitis

Witch hazel, found in herbal medicine, sold in the form of a 10% distillate with an indication for ophthalmic use or contained in some tear substitutes can be a valid natural remedy against conjunctivitis.

Like chamomile, mallow is also a medicinal plant with a calming effect, suitable for use with eye compresses in case of conjunctivitis.

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In herbal medicine it is possible to buy it in sachets for the preparation of an infusion, following the instructions on the package.

Finally, eyebright is a herbal remedy suitable for relieving the symptoms of conjunctivitis inflammation available in herbal medicine for the preparation of an infusion which must be filtered and used cold for the preparation of compresses with a calming effect to be applied on the eyes.

Prevent contagion

Bacterial conjunctivitis is very contagious, so the person affected by this infection must apply all forms of hygiene to prevent transmission to other people or to the other eye, in case the problem is localized in only one eye.

To prevent contagion it is essential:

always wash your hands thoroughly before touching the inflamed eye
constantly maintain a thorough cleaning of the affected area
do not use contact lenses
apply hot-humid or chamomile-based compresses, which have soothing and anti-inflammatory properties

Furthermore, a good rule would be to change pillowcases and towels frequently, often disinfect household items in common with cohabitants, do not use cosmetics and do not wear make-up until complete recovery.

Children, students and workers (especially those who practice their profession in public settings) should stay at home for the entire time of therapy or until the bacterial conjunctivitis is no longer contagious.

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