Dear Dr Nina: How to we deal with repeat conjunctivitis?
We have two small children — aged five and two — and over the past two years the whole family has endured repeated bouts of conjunctivitis. It usually starts with one or the other of the kids and within a week everyone has it. I’m well aware that it’s contagious and I do my best to ensure everyone washes hands, uses separate towels and pillow cases, etc, but it still seems to spread like wildfire. Neither myself nor my husband had ever got conjunctivitis before. Are you more susceptible once you’ve had it once? Could we suffer lasting problems with our eyes as a result of these repeated infections? They are very painful.
Dr Nina replies: Conjunctivitis causes redness of the white part of the eye. The eye may feel itchy, gritty or burning. There may be increased production of tears, leading to a watery eye. Discharge can occur and may be waxy or crust along the eyelashes. There may be an urge to rub or itch they eye and this can lead to some swelling of the eye itself.
You mentioned your eyes are painful. A gritty or uncomfortable feeling is associated with conjunctivitis, but marked pain is not. If you have severe eye pain or a change in vision, you should attend a doctor urgently.
Conjunctivitis may be bacterial, viral or allergic. There are some similarities between the three types but the treatment differs for each.
Bacterial conjunctivitis usually occurs in one eye but may sometimes spread to the other. It can come on quite suddenly and cause redness of the eye along with a sticky pus-like discharge that may appear along the lashes causing them to stick together. It is a leading cause of absence from crèche or playschool among young children.
Most cases are quite mild and will resolve over a number of days.
Viral conjunctivitis usually starts in one eye and rapidly spreads to the other. The eye becomes inflamed and red. Viral causes often occur in combination with other symptoms of the common cold such as runny nose, sore throat or flu-like feeling.
Allergic conjunctivitis usually occurs in both eyes. It is commonly associated with other symptoms of hay fever such as runny nose, itchy throat and in those with eczema and asthma. It often peaks in seasons when pollen counts are higher.
When conjunctivitis first occurs, it is reasonable to start by wetting the eye gently or applying cool or warm compresses to soothe the eye. Adding some baby shampoo to the water can help remove any waxy crusting of the eyelashes.
Taking an antihistamine or buying anti-allergy drops over the counter in the pharmacy may help. Artificial tears can be applied frequently and may also soothe the eye.
If simple over-the-counter methods aren’t helping or if there is persistent discharge or crusting of the lids, it is worth seeing your doctor.
Antibiotic ointments and drops are usually prescribed if a bacterial cause is suspected. Prescription anti-allergy drops or the addition of a nasal spray can help relieve allergic symptoms. Viral conjunctivitis only rarely requires prescription medication.
As many cases of conjunctivitis are highly contagious, it is advisable to avoid close contact with others until treatment has kicked in.
Conjunctivitis often spreads through households so the pattern you describe is not unusual. Bacterial and viral conjunctivitis don’t normally reoccur and there is no reason you should get it more often having experienced it previously.
Allergic conjunctivitis however can reoccur. If you have associated allergies or hay fever, this may explain frequent episodes. If episodes are treated promptly and appropriately, there is no reason chronic eye damage should occur.
Q. I have struggled to lose weight all my adult life and now my doctor says that I am prediabetic and should start a drug called metformin, but I’d prefer to keep trying diet and exercise.
Dr Nina replies: Prediabetes means that your fasting blood glucose levels are higher than normal but not high enough to be diagnosed as Type 2 Diabetes. This is also referred to as impaired fasting glucose or impaired glucose tolerance. It is important to address this issue, as without intervention pre diabetes is likely to progress to diabetes in 10 years or less.
We also know that those with prediabetes already have an increased risk of cardiovascular disease. One study showed that 8pc of those with prediabetes already had evidence of diabetic changes in the eye. The most important thing to do when you have prediabetes is to lead a healthy lifestyle. If you are overweight, aim to lose 5pc to 10pc of your body weight. Move more. Eating a healthy diet is essential. Your diet should include lots of fresh vegetables, and carbohydrates eaten should be whole grain. Portion control is extremely important, whatever the food.
Your doctor can assess your overall risk of cardiovascular disease and the risk or progressing to diabetes. It is important that your cholesterol and blood pressure are normal. If your doctor feels that your overall cardiovascular risk is high and that you are very close to full type 2 diabetes, then metformin maybe a reasonable suggestion, especially if you have tried really hard to improve your lifestyle and sugars remain high.
Metformin has been shown to reduce the progression to Type 2 diabetes by 21pc. Lifestyle is still the most important, reducing the risk by 28pc. The two combined would likely be even more effective. If you have concerns talk to your GP openly about them and hopefully a plan you are happy with can be achieved.
Health & Living