Bacterial Conjunctivitis: Signs, Types, and Purulent Discharge

The morning doesn't start with coffee but with an attempt to unstick your eyelashes: yellow marks on the pillow, a red eye, a stuck-together eyelid. This picture often points to conjunctivitis, and one of the common causes is bacteria. Let's look at what the bacterial form looks like and when it's time to see a doctor.

Bacterial conjunctivitis: what it is

Conjunctivitis is inflammation of the conjunctiva, the membrane that covers the outer layer of the eye and the inner surface of the eyelid. It is this membrane that becomes red, itchy, and produces discharge.

There are several causes: bacterial or viral infection, allergy, irritants, contact lens solutions, eye drops and ointments. The bacterial form is the one in which pyogenic, that is, pus-forming, bacteria are involved.

The numbers help put this in perspective: in adults, about 85% of conjunctivitis cases are caused by adenoviruses and only 15% by bacteria. In children, bacterial and adenoviral variants occur equally often.

What this looks like: an adult with red eyes after the office more often has a viral story, while a child from daycare with sticky eyelashes is equally likely to have a bacterial one. Conjunctivitis with sticky pus is contagious. For example, Koch-Weeks conjunctivitis is transmitted through the patient's contaminated hands and infected objects. Symptoms usually appear about the third day after infection.

Purulent conjunctivitis: symptoms

The first noticeable sign is a viscous, opaque, gray or yellowish discharge. Because of it, the eyelids stick together, especially after sleep.

• redness of the white of the eye and swelling of the eyelids;
• stuck-together eyelashes and crusts in the morning;
• dryness of the eye and the skin around it;
• a foreign body sensation, tearing, photophobia;
• pain in acute purulent infection.

Discharge is not the only marker. Chlamydia trachomatis and Moraxella can cause persistent conjunctivitis without pronounced redness, and in some people it all comes down to a feeling of a speck in the eye. Usually one eye is affected first, then the infection spreads to the second.

A quick morning check: are there yellow marks left on the pillow, do the eyelashes stick together after sleep, does the eye become red beyond the eyelid. This is an observation, not a diagnosis.

Chlamydial and gonococcal conjunctivitis

Chlamydial conjunctivitis may occur without pronounced redness and copious discharge, but may be persistent.

Gonococcal, or blennorrheal, conjunctivitis develops in newborns when passing through the birth canal of a mother with gonorrhea. At first the discharge is serosanguineous, and after 3–4 days it becomes copious and purulent. Sexually transmitted infections in general cause conjunctivitis that takes longer to heal.

Bacterial conjunctivitis in children and newborns

In children, bacterial and adenoviral forms occur equally often. Purulent conjunctivitis in a child under two years of age usually requires a doctor's prescription, so a conversation with the pediatrician should not be delayed.

Newborns are a separate story. Red, stuck-together eyes in a child under 30 days of age are a reason to see a doctor urgently.

How bacterial conjunctivitis differs from viral and allergic

The viral form usually starts in one eye, then spreads to the other, often against the background of a cold or sore throat, with fever and enlarged preauricular lymph nodes. The discharge is scanty and not purulent; in children there may be follicles and membranes.

Allergic conjunctivitis is intense itching, redness, eyelid swelling, and tearing without pus. It is not contagious. The bacterial and viral forms with sticky discharge, on the contrary, are easily transmitted from person to person.

Possible complications and when to see a doctor

Some conjunctivitis cases resolve on their own within a couple of weeks without treatment, but the bacterial form is the one where the doctor decides whether intervention is needed. With gonococcal (blennorrheal) conjunctivitis, corneal infiltrates and ulcers are possible. A prolonged course is also typical of the chlamydial form.

See a doctor if symptoms do not subside within 7 days, if you wear contact lenses and spots on the eyelids appear at the same time, if a child under 30 days of age has red, stuck-together eyes.

Bacterial conjunctivitis by itself is not a reason to call an ambulance; 103/112 — for a life-threatening condition. Eye pain, photophobia, changes in vision (wavy lines, flashes), very red eyes, as well as red, stuck-together eyes in a child under 30 days of age are a reason to see a doctor urgently the same day.

This text is for reference: it helps you ask the doctor the right questions, but does not replace a consultation with a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer