Conjunctivitis (Pink Eye) in Older Adults
The Conjunctiva and Conjunctivitis
The conjunctiva is a thin mucous membrane that covers the white part of the eye and lines the inside of the eyelid. The membrane is usually clear and colorless, but if it's irritated or infected the it may become inflamed. Symptoms of this inflammation include red and itchy eyes, swollen eyelids and an eye discharge. The inflammation is known as conjunctivitis or pink eye.
Our eyes produce several types of tears. One type is released regularly to form a protective film over the surface of the eye. These tears wash particles away from the eye's surface and also contain chemicals that fight infection. This helps to prevent conjunctivitis. Unfortunately, older people - especially women - often produce fewer of these beneficial tears than younger people and have an increased chance of developing conjunctivitis. Low tear production can result in chronically dry eyes, a condition known as dry eye syndrome or keratoconjunctivitis sicca.
An Ophthamologist Discusses Pink Eye
Types and Causes of Conjunctivitis or Pink Eye
There are several types of conjunctivitis. Infective conjunctivitis is caused by a bacterium or a virus; allergic conjunctivitis results when the eye is exposed to an allergen; and irritant conjunctivitis is produced when a person's eye comes in contact with irritating chemicals. Wearing contact lenses for a long time may also irritate the eyes and cause conjunctivitis.
Infectious Conjunctivitis Caused by Viruses
The most common cause of infectious conjunctivitis is a virus. In most cases there is no medical cure for the infection, so the body has to deal with the problem by itself. (Antiviral drugs are available to fight a few viruses that cause conjunctivitis.)
Generally it takes about a week to ten days before the redness and itching of viral conjunctivitis disappear. During this time it's easy to pass the infection to someone else or to pass it from one eye to the other if only one eye is infected. Therefore it's important to carefully follow the suggestions in the "How to Prevent Conjunctivitis" section of this article. Viruses that cause the common cold and the flu can both cause conjunctivitis.
Infectious Conjunctivitis Caused by Bacteria
Bacterial conjunctivitis produces similar symptoms to viral conjunctivitis, except there is a thick, yellow and sticky discharge released from the eyes instead of the watery discharge present in viral conjunctivitis. The bacteria that infect the conjunctiva may come from the person's own skin or respiratory tract or they may be transferred from another person who has conjunctivitis. It's possible to have both viral and bacterial conjunctivitis at the same time. Bacterial conjunctivitis can be treated with antibiotic eye drops.
Conjunctivitis can be caused by allergic reactions to materials such as pollen grains, dust mites and pet dander (skin cells that are shed by the pet).
Examples of substances that can trigger irritant conjunctivitis include cigarette smoke, pollutants, chlorine in swimming pools, some fragrances, soap, hairspray, cleaning liquids and diesel exhaust.
Symptoms of Conjunctivitis
People suffering from conjunctivitis experience one or more of the following symptoms.
- itchy or painful eyes
- a red and bloodshot sclera (the "white" of the eye) and red inner eyelids
- increased tear production
- an eye discharge
- blurred vision
- swollen eyelids
- sensitivity to light
- a gritty sensation in the eyes
- the formation of a crust on the inside of the eyelid while the person sleeps
- sticky eyelids
- difficulty in opening the eyes
Conjunctivitis can develop in one or both eyes.
How to Get Rid of Conjunctivitis
Whenever I get pink eye, the problem clears up on its own within a few days. The CDC says that it isn't always necessary to seek a doctor's advice when experiencing conjunctivitis. It lists some situations where a medical consultation is important, however. These include the presence of moderate or severe pain, intense redness or vision problems. A condition that fails to clear up on its own or with self treatment also requires medical treatment.
Conjunctivitis is annoying, uncomfortable and embarrassing, but it's generally not serious. There are exceptions to this rule, though. One exception is conjunctivitis that is caused by sexually transmitted bacteria. These can infect other parts of the body and may cause serious eye damage, including blindness.
The treatment of conjunctivitis depends on its cause and on a doctor's advice.
- Artificial tear solutions may help to relieve the discomfort of viral conjunctivitis. These solutions are sometimes called lubricating eye drops. Some artificial tear solutions contain preservatives which can irritate the eyes, however. It's safer to buy preservative-free solutions, even though these are more expensive.
- Antibiotic eye drops, ointment or pills are frequently prescribed for bacterial conjunctivitis.
- Antihistamine eye drops and pills can help allergic conjunctivitis.
- In severe cases of allergic conjunctivitis, a doctor may prescribe corticosteroid eye drops.
- Avoiding further exposure to allergens or irritants will help to relieve allergic or irritant conjunctivitis.
- Cool compresses applied several times a day may soothe the eyes and reduce redness and swelling in any type of conjunctivitis. (Use a clean washcloth to make each compress.)
Decongestant eye drops, also known as whitening eye drops, are available in stores. These drops reduce the bloodshot appearance of eyes by shrinking the blood vessels in the cornea. However, if they're used too often they may cause rebound hyperemia, a condition in which the redness in the eyes is increased instead of decreased.
Pink Eye in Children or Adults
How to Prevent Conjunctivitis or Pink Eye
In order to prevent conjunctivitis it's important to keep the eyes clean. This is especially true for older adults, who don't get as much help from tears as younger people. Here are some tips that will reduce the chance that you will develop conjunctivitis.
- Keep your hands away from your eyes as much as possible.
- Wash your hands regularly. It's easy to rub an eye without thinking about it.
- Make sure that anything that comes close to your eyes, such as cosmetics, towels and washcloths, is clean.
- Don't share towels or washcloths with other people.
- Buy fresh eye cosmetics regularly and discard the old ones.
- Handle and clean extended wear contact lenses properly.
- Wash pillow cases frequently.
- If you use a tissue on your face or to wipe your nose, discard it immediately and safely after use so that it doesn't infect your eyes or those of other people. In addition, wash your hands.
- If you have chronic dry eyes, visit a doctor to determine the cause. If you are advised to do so, use a treatment that increases the presence of tears.
A problem with tear production increases the risk of conjunctivitis. As we age, we produce fewer beneficial tears and the chance of developing conjunctivitis increases.
The Tear Film
Types and Functions of Tears
There are three types of tears, which differ slightly in composition. Basal tears lubricate the eye. Irritant or reflex tears are made in response to irritants in the eyes, as their name suggests. The third type of tear is the emotional or psychic tear.
Basal tears are the most important type with respect to dry eyes. They are a mixture of three types of fluid - an outer oily layer, a middle watery layer and an inner mucus layer - which are made by glands around the eye.
- The oil component is made by glands at the edge of the upper and lower eyelids called meibomian glands. The oil stops the tears from evaporating once they are spread over the eye.
- The lacrimal gland produces the watery component of the tears, which forms the majority of the tear. This watery material contains proteins. The lacrimal gland is located above each eye, towards its outer edge, and sends its secretion to the eye via ducts.
- Goblet cells in the conjunctiva produce mucin, which forms mucus when mixed with water. The mucus layer helps the tears stick to the eye.
Every time we blink, tears flow over the surface of the eyes. The tear film lubricates the eyes, keeps them moist and cleans them. Tears are necessary in order for us to have clear vision. They also contain antibodies and enzymes that destroy bacteria and viruses. Once they have covered the front of the eyes, any left over tears enter drainage ducts in the inner corner of each eye. These ducts transport the fluid to the back of our nose.
Tears and Dry Eyes
Tear Production in Older Adults
Tear production decreases as we age. According to the American Optometric Association, the "majority" of people over the age of 65 have some dry eye symptoms. Dry eyes are more common in women than in men, especially after menopause. Hormonal changes are believed to be at least partly responsible for the decreased tear production. There are other possible reasons for tear reduction besides age, however, so if you're an older person with dry eyes don't assume that your problem is due to your age.
The technical name for chronically dry eyes is keratoconjunctivitis sicca, or dry eye syndrome. This condition can make blinking painful and cause the eyes to feel gritty. The eyes may also be red and irritated.
There may actually be an increase in tear production in dry eye syndrome, but these are irritant tears and aren't helpful for lubricating the eye. Prolonged or severe dry eye syndrome can damage the cornea on the surface of the eye, which is normally protected by a tear film.
Other Causes of Dry Eyes Besides Aging
Some factors that may cause dry eye syndrome in addition to age are certain medical conditions (such as rheumatoid arthritis, lupus, diabetes and Sjogren's syndrome) and certain medications (including antihistamines, decongestants, diuretics and some drugs that are prescribed to treat high blood pressure). It's also possible that eyelid problems are reducing the blinking rate, thereby reducing the flow of tears over the eye. A vitamin A deficiency may cause dry eyes as well. There is some evidence that a diet low in omega-3 fatty acids may predispose a person to developing dry eyes.
Being in a windy environment or in one with dry air can cause dry eyes. So can activities that reduce blinking, such as prolonged work at a computer, driving, reading or studying. Certain types of laser eye surgery may reduce tear production temporarily, too.
Blepharitis - Another Possible Cause of Dry Eyes
Blepharitis is an inflammation of the eyelids around the eyelashes. It's often (but not always) caused by an infection. The inflammation can interfere with the action of the oil-producing meibomian glands, which are also in the eyelids by the lashes. Sometimes a problem with these glands is the cause of blepharitis rather than the result. In either case, since the oil from the meibomian glands reduces the evaporation of the tear film, without its presence dry eyes may result.
What is Blepharitis?
How to Treat Dry Eyes
If you are suffering from chronically dry eyes, it's important to visit a doctor and find out why. The problem may be easily solved. It may be due to another illness that must be treated, however.
If the doctor finds that there is no obvious cause for dry eyes, such as a medical condition or the use of a particular medication, artificial tears may be a useful aid. They can relieve discomfort, improve vision and help improve the condition of the surface of the eye.
Preservative-free artificial tears come in single use containers, so using them regularly may become expensive. Artificial tears with a preservative are less expensive and a bottle lasts for a longer time. As long as the preservative doesn't irritate the eyes they can be a good product to use.
Dry Eyes and Their Treatment
Medical Treatment for Dry Eyes
Eye doctors today have a wide variety of possible treatments to help dry eyes. There are other types of eye drops and medications that doctors can prescribe to help patients in addition to common drug store products.
In a serious case of dry eyes that doesn't respond to conservative treatment, a surgeon may block the drainage ducts that remove tears from the eyes, causing the tears to stay in the eyes for a longer time period. The blocked drainage ducts can be opened at a later date if necessary.
It's worth finding a good solution to a dry eye problem in order to reduce discomfort and the possibility of cornea damage. Like conjunctivitis, dry eyes may be an uncomfortable but temporary problem. Any eye disorder that is painful, becomes chronic or occurs repeatedly needs to be investigated by a doctor, however, in order to protect vision.
References and Further Reading
© 2012 Linda Crampton