As a Charleston optometrist,
I see my fair share of red eye balls. Occasionally, i’ll see patients outside of the office whose eyes look red. Inevitably, they’ll come up to me and say “Hey doc! My eye is red, I think I have pink eye. What do you think?” And after a quick glance at each eye I’ll typically say, “Yep, your eyes are red, but….” And then I ask a series of questions to rule out the presence of the nasty, icky, pink eye that everyone thinks they have when their eyes are red. You know the kind of pink eye that your kids bring home from school that spreads like wildfire through your whole household???
The medical term for a red or pink eye is conjunctivitis, which means that the conjunctival layer of the eye or eyes is inflamed. The conjunctiva is a thin layer of tissue that covers the eyeball and the inside portions of the upper and lower eyelids. This layer of the eye has its own lymphatic network (immune system) that runs through it to help protect the layers underneath it from external sources such as bacteria, allergic substances, and yes, viruses. When something gets in the eye that this lymph tissue doesn’t like, it sends messages to nearby blood vessels to expand so that more immune cells can come in and do their job. So the redness that you see is actually dilated blood vessels that are also found in the conjunctival layer. What’s causing the reaction is always the fun part to figure out!
What the heck is causing the issue?
When we look through our eye doctor gizmo’s, we can see what type of reaction the conjunctiva is having, because the lymphatic tissue will react differently to what is causing the issue. Under the microscope there are a bunch of different types “little bumps” (immune reactions) that are present. Our job is to evaluate what type of “bump” we are looking at, and pair that with the symptoms that the patient is having. Along with what we see under the microscope, the symptoms felt by the patient will also point to the problems, because as humans we all react fairly consistently to outside invaders. Symptoms like the type of discharge coming out of the eye, itchyness, pain, having a recent cold, swollen lymph nodes, etc, are all as important as what we look at on the eyes.
So really doc, do I have it or not?
To be quite honest, when I know I have a case of this sitting in my exam chair, I get the heebie jeebies. Because I know what the symptoms are, and even without having looked at the eye under the scope, I am usually about 90% correct when it’s the nasty type. This viral type of conjunctivitis, diagnosed as Epidemic Keratoconjunctivitis or EKC, is extremely contagious, and can last for weeks. It usually goes about 3 weeks on average, but if severe enough, it can lasts for months. The virus has an incubation period of 2 to 10 days. This means that the more contact the virus has with the eye, the more dysfunction it will cause. EKC is caused by several different strains of adenovirus, better known the cold virus. Different strains are worse than others. Some cause the cornea can be affected which can cause blurry vision for an extended period of time.
The symptoms that you will see are consistent across the board. It typically starts with redness and a bunch of watering in the eye is effected. You will also have a swollen lymph node above the jaw near the ear on the same side as the red eye. The eye can be kind-of-red to beet-red, and can be hard to open in the morning after sleep because of all of the discharge that will come out of it during the night.
What do I do now?
Well, do you remember when I talked about the incubation period? In this case, the best course of action is to reduce the amount of virus in the eye so that the amount of potential viral dysfunction is minimized. And we do this with either an eye wash or non-preserved artificial tears. Buffered saline eye wash sounds like a good idea, but you have to be careful from getting it into the other eye. Remember, we are dealing with a highly contagious virus, and having it in both eyes is not fun at all. So using a couple of drops of non-preserved artificial tears, found at your local store, every hour is a the best option. Flushing the eye will clean out free floating virus, therefore minimizing incubation.
But sometimes, the virus sets in so quickly that an eye rinse won’t help. Unfortunately, there are no drops or medicines that deal directly with EKC. I have tried some off-label use with a very expensive antiviral drop that has been so-so in solving the issue. This probably has to do with what type of adenovirus strain is causing the problem, but i intend to watch for more studies done on this med. Steroid drops can help make the patient feel better, but they typically don’t do a lot. So sometimes, it can be a grin and bear it type deal, where time is the ultimate factor and your bodies immune system will take care of it.
What else can I do?
To reduce the chance of it getting into the other eye, or for a family member to get it, wash your hands as much as possible, and change your bed linens often. If you feel it is getting out of hand, go see your eye care provider and get some recommendations or treatment.
Hope this helps!
Mike Morabito, O.D.