Introduction

Most of us have come across the season of pink eyes at least once - did you know that pink eye is one of the most common eye infections in the world? It affects people of all ages, from newborns to the elderly. This article will give you a deeper understanding of common eye infections like pink eye and how to recognise them early and manage them effectively.

Why is managing eye infections so crucial?

Your eyes are one of the highly specialised sensory organs. Its complex design plays a vital role in providing a clear picture of what you see. Any damage or infection to any of the layers of the eye should be treated quickly as delays may lead to a number of serious long-term complications and vision loss.¹ It is vital that you undergo prompt treatment or follow a management strategy to prevent complications and preserve your eye health.

What are the most common eye infections?

Eye infections are very common around the world and an infection can target any part of your eye, such as the eyelids, cornea, conjunctiva or tear ducts. Eye infections are common among individuals who have poor hygiene with contact lenses.²

• Pink eye
• Keratitis
• Blepharitis
• Endophthalmitis
• Uveitis
• Orbital cellulitis
• Dacryocystitis
• Stye
• Chalazion

Pink eye 

Pink eye is the common term used for conjunctivitis which is an inflammation of the conjunctiva. The conjunctiva is the thin, transparent membrane that covers your inner eyelids and the white part of your eyeball. Pink eye (conjunctivitis) can be caused by either viruses,  bacteria or irritants like allergens. Although it affects people of all ages, it is common amongst young children and highly contagious if the cause is microbial.³

Keratitis

Keratitis is also called inflammation of the cornea, the outermost, transparent layer of the eye which covers the iris and pupil. The corneal inflammation can either be infectious (caused by bacteria, viruses, fungi or parasites) or noninfectious (prolonged wear of contact lenses, accidental burns, surgery or autoimmune disorders).⁴ Keratitis usually affects the working age group.⁵

Blepharitis

Blepharitis is known as the inflammation of the eyelids. This condition develops when the oil glands under the eyelids get clogged. Blepharitis always affects both eyelids at once. Both children and adults are equally affected. Generally, blepharitis is not contagious or serious. However, it is a chronic condition that doesn't go away completely and requires regular care.⁶

Endophthalmitis

Endophthalmitis is the inflammation of intraocular cavities filled with fluids called aqueous humour and vitreous humour due to an infection (bacterial or fungal). The cause of the infection is mostly trauma or a recent surgery like cataract or glaucoma implants. Very rarely, endophthalmitis is caused by an ongoing infection in another body part that spreads to the eye via bloodstream.⁷ Although endophthalmitis is not contagious, it is a mildly threatening condition. 

Uveitis

Uveitis occurs when the middle layer of the eye called the uvea (iris, ciliary body and choroid) gets infected. It is a common condition among adults and usually affects only one eye. Uveitis can be caused by ongoing infections, autoimmune diseases inflammatory disorders or an eye injury.⁸ If not diagnosed early or left untreated, uveitis can potentially be a blinding disease as the inflamed uvea can possibly change the eyeball shape and damage the optic nerve^.9

Orbital cellulitis

Orbital cellulitis is the infection of the skin, fat and muscles around the orbit of the eyes, mostly bacterial. It is common among young children. Infections in the skin, mouth, ears or sinuses can spread to the eye orbits. This condition can be severe with long-term symptoms, even blindness.¹⁰

Dacryocystitis

Dacryocystitis is the inflammation of the lacrimal (tear) sac due to a bacterial infection. This occurs when your nasolacrimal (tear) ducts get clogged causing stagnation of the tears inside the sac. It affects newborns and adults and the infection can resolve fast (acute) or last longer (chronic).¹¹ Sometimes, people who have their tear ducts clogged are also at risk of orbital cellulitis.

Stye

Stye, also medically referred to as hordeolum, is a condition that develops when an oil gland in your eyelids or eyelashes gets clogged and infected. The infection is mostly bacterial and can affect both the outer and inner eyelids. Most often, you will notice a red, painful, pimple-like bump that grows at the edges of your eyelids.¹²

Chalazion

Chalazion looks similar to stye. You will notice a swollen bump due to a clogged-up eyelid’s oil glands when you are affected by this condition. However, you will hardly feel any pain. As the bump grows, your eyelids may become largely swollen and press against the cornea which may blur the vision^12,13.

There is a high possibility of stye or chalazion, if you have blepharitis. Adults are more prone to both types of infections than children.¹²

What are the general symptoms of eye infections?

The following are the general symptoms that you might experience in eye infections. However, the degree of the symptoms varies depending on the severity.¹⁴

• Reddening of the eyes and the eyelids
• Excessive tearing 
• Watery or sticky, yellowish discharge forming crusts on the eyelashes and making the eyelids stick to each other often seen during sleep
• Itching or irritation in the eye causing frequent rubbing
• Some may have a sudden onset of burning, gritty or foreign body sensation 
• Swollen eyelids 
• Sensitivity to light (photophobia) 
• Although rare, temporary blurred vision is seen in severe cases

What are the specific symptoms of different types of eye infections?

Other than the general symptoms, you may also notice varying and specific symptoms for different types of eye infections depending on the cause.

Pink eye

• Viral conjunctivitis is associated with cold-like symptoms such as sneezing, coughing and sore throat 
• Bacterial conjunctivitis may cause more eye discharge and crusting
• Allergic conjunctivitis causes other allergic symptoms such as sneezing, nasal congestion, or itchiness¹⁵

Keratitis

Corneal inflammation and excessive pain in the eye are typical of keratitis. You may also have difficulty opening your eyelids due to the pain. Besides that, keratitis may cause corneal ulcers which may lead to decreased vision.¹⁶

Blepharitis

The typical symptoms of blepharitis are:

• Swollen and shiny eyelids
• Dandruff-like particles on your eyelashes
• Excessive blinking
• Loss of eyelashes
• Misdirected eyelashes - a condition in which your eyelashes grow toward the eyes rather than away from them called trichiasis.¹⁷

Endophthalmitis

If you have excessive pain immediately after an eye surgery, it could be endophthalmitis. 

Along with pain and even loss of vision is highly possible in individuals with endophthalmitis if not treated timely.¹⁸

Uveitis

The following symptoms are typical of uveitis, despite cloudy vision.

• Changes in pupil shape change (does not remain circle) 
• Hypopyon - accumulation of white blood cells at the bottom of the anterior chamber (front) of the eye¹⁹
• Excessive floaters and defects in the visual field²⁰ 

Orbital cellulitis

• The skin around your eyes gets swollen
• Excessive pain during eye movements
• Protopsis (bulging eyes) 
• Diplopia (double vision)²¹

As orbital cellulitis is common among children, if they come across symptoms like a high fever along with bulging eyes and/or swelling around eyes, you should have them see an emergency doctor right away.

Dacryocystitis

The typical symptoms of acute dacryocystitis include: 

• significant eye pain and swollen eyelids.
• Fever
• Abscess with discharge (pus) in the inner corner of the eyelids²²

Stye and chalazion

Stye and chalazion have similar symptoms like red and swollen eyelids (entirely), excessive tears and mild irritation except that the bump you notice at the edge of your eyelids is painful in stye.²³

General management principles for all eye infections

The following measures help in faster relief and prevent spreading. 

• Gently wipe the eyelashes with a cotton pad soaked in cool, sterilised water to clean off the sticky crusts
• Hold a cold soft cotton cloth onto the affected eye (s) to soothe irritation
• Use artificial tears and cool compresses to relieve dry eyes and inflammation
• Practise good hygiene such as frequent washing of hands and avoiding touching or rubbing eyes with unclean hands to prevent spreading
• Avoid dust, irritants or allergens
• Stop wearing contact lenses until the symptoms subside
• Avoiding eye make-up
• Using protective eye gear while using heavy machinery or playing sports

Specific treatment options for different types of eye infections

Pink eye 

Generally, you do not need any treatment or medical attention. Pink eye will go away on its own in a couple of weeks completely.

However, medical attention or medicines are needed in case of the following:

• Newborns or infants with symptoms should see a doctor right away.
• A severe form of viral conjunctivitis needs antiviral medication
• Some cases of bacterial conjunctivitis need a topical antibiotic cream or drops to shorten the span of infection 
• Allergic conjunctivitis can be managed using antihistamine eye drops or oral medications²⁴

Keratitis

You should never touch your eyes or the surface around your eyes if you have a herpes blister, even if you have washed your hands with soap.

In mild cases of keratitis, only lubricating eye drops can help you to heal completely. If the cause is microbial, your doctor will give antibiotic drops (bacterial), antifungal eye drops or antiviral eye drops according to the cause. Sometimes, you may need steroid eye drops to reduce the inflammation, once the infection subsides.²⁵

In severe cases of keratitis with corneal ulcers and successive scarring, one may need a corneal transplant.

Blepharitis

If you ever encounter blepharitis, eyelid scrubs are one great option to remove dandruff particles from your eyelashes.

Your ophthalmologists will provide antibiotic drops and/or ointment (bacterial), steroids (to reduce inflammation) or immunomodulators (to weaken the body's natural immune response) depending on the cause of the infection.²⁶

Endophthalmitis

Endophthalmitis requires prompt medical attention. You may get topical drops or injections of antibiotics, antifungals or corticosteroids depending on the cause. 

In the case of severely affected people, ophthalmologists suggest a surgical procedure called vitrectomy - to remove the infected vitreous humour and inject antibiotic or antifungal medication inside your eye to prevent further infection.²⁷

Uveitis

The specific treatment for uveitis includes:

• Steroids to reduce pain and inflammation
• Immunosuppressants²⁸ 
• Cryotherapy (temporary freezing of part of the eye) and laser phototherapy²⁹

Orbital cellulitis

A complete course of antibiotics, preferably intravenous, is the treatment protocol if you have orbital cellulitis.³⁰

Dacryocystitis

Despite antibiotics, your ophthalmologists may suggest dacryocystorhinostomy - a surgical procedure to create a new pathway for your tears.³¹

Stye and chalazion

Never try to squeeze or pop the bump on the eyelid caused by stye or chalazion, it may worsen the problem. You may need to drain the bump if it blurs the vision.

Summary

Different types of eye infections have different causes and they require management strategies tailored to the underlying cause. The symptoms specific to each infection aid in early recognition of the problem. If we promptly recognise an infection, we can quickly alleviate discomforting symptoms and prevent outbreaks. Additionally, embracing effective management strategies can help us to come out of the eye infection faster and prevent vision loss.