Eye Infections

What is an eye infection?

An eye infection is a disease of the eye that occurs when bacteria, fungi, parasites and viruses get into your eye.^1,2 This can occur due to:^1,2

• Injuries (e.g. A scratch) or trauma
• Physical contact with an infected person
• Touching a contaminated surface and then touching your eye

You can also develop an eye infection if you sleep in your contact lenses or don’t clean them properly.¹

Types of infections include:^1,5–12

• Blepharitis – inflammation of the eyelids due to an infection or clogged oil glands. Blepharitis isn’t usually contagious
• Keratitis (corneal ulcer) – inflammation of the cornea (the clear outer layer of your eye). Keratitis can be either infectious or non-infectious (due to trauma)
• Orbital cellulitis – a bacterial infection of the tissue that surrounds your eye. Orbital cellulitis most commonly affects children under the age of seven and can cause vision loss and even lead to sepsis
• Dacryocystitis – inflammation or infection of your tear sac due to blocked tear ducts. Dacryocystitis isn’t usually contagious
• Conjunctivitis (pink eye) – inflammation of the conjunctiva, the clear membrane that covers parts of your eyes and the inside of your eyelids. Conjunctivitis is the most common type of eye infection and can be highly contagious
• Endophthalmitis – inflammation and infection of the fluids within your eye. Endophthalmitis is not contagious
• Stye – a painful red bump on the edge of your eyelid that forms when a tiny oil gland near your eyelashes becomes blocked and gets infected. A stye generally isn’t contagious
• Uveitis – inflammation of the uvea (the middle layer of your eye). Uveitis is not contagious
• Ocular herpes (herpes simplex) – a viral infection caused by the same virus that produces cold sores. This is a serious condition that needs urgent medical treatment. Some types of ocular herpes can be contagious
• Trachoma – an eye disease caused by a bacterium called chlamydia trachomatis. Repeated infections can cause scarring and blindness. Trachoma is highly contagious

Eye infection symptoms and treatments

Many viral, fungal or bacterial eye infections share symptoms, such as swelling and redness. However, there are unique differences between each infection that can help you to tell them apart.

Blepharitis

Symptoms of blepharitis include:^5,15

• Swollen, sore eyelids
• Red, irritated eyes
• Itchy eyes
• Flakes or crust around your eyes and eyelids
• Eyelids sticking together in the morning when you wake up
• dry eyes or excessive tearing
• Excessive blinking
• Photophobia (light sensitivity)
• Blurred vision
• Loss of eyelashes
• Eyelashes that grow toward your eyes rather than away from them (trichiasis)

To treat blepharitis yourself, clean your eyelids twice a day, even when your symptoms clear up.¹⁵ The NHS provides specific instructions on how to do this.

If your blepharitis does not clear up, your GP may suggest using an antibiotic cream or ointment.¹⁵

Keratitis

Symptoms of keratitis include:^12,16

• Red eyes
• Eye pain
• Watery eyes
• Difficulty opening your eyes because of pain
• Blurred vision
• Decreased vision
• Photophobia
• A feeling that something is in your eye

Treatment for keratitis will depend on the cause of the infection.¹⁷ Usually, it is treated using antibiotic eye infection drops, which may need to be used throughout the night if the infection is severe.¹⁷ If your keratitis is due to a bacterial infection, you will also be treated using hourly antibiotics.¹⁷

Orbital cellulitis

Symptoms of orbital cellulitis include:^6,18

• Swollen upper and lower eyelids, and possibly the eyebrow and cheek
• Bulging eyes
• Shiny, red eyelids
• Pain or difficulty when moving your eye
• Double vision
• Decreased vision
• Fever

A hospital stay is generally needed to treat orbital cellulitis, where antibiotics will be given through a vein.^6,18 When your child’s symptoms improve, they will be able to go home and continue treatment with oral antibiotics.^6,18 Occasionally, surgery is required to relieve pressure in the space around the eye.^6,18 

Dacryocystitis

Symptoms of dacryocystitis include:^7.19

• Eye pain
• Swelling around your eye
• Redness in the inner corner of the eye
• Oozing pus in the inner corner of your eyelids
• Fever
• Watery eyes

Most commonly, dacryocystitis is treated using oral antibiotics.^7.19 However, in very severe cases antibiotics may be given through a vein.^7,19

If you have recurrent episodes of dacryocystitis, you may be recommended a surgical procedure called dacryocystorhinostomy (DCR), to create a new pathway for your tears and prevent reinfection.

Conjunctivitis

Symptoms of conjunctivitis include:^9,20

• Red eyes
• Yellowish, greenish or white discharge which causes crusting
• A feeling that something is in your eye
• Dry eyes or watery eyes
• Itchy eyes
• Burning eyes
• Blurred vision 
• Photophobia
• Swollen eyelids
• Mild eye pain 

You can typically treat conjunctivitis yourself by washing your eyelids with boiled water that’s been allowed to cool.²⁰ You can also buy optrex infected eyedrops for conjunctivitis over the counter.^9,20

Endophthalmitis

Symptoms of endophthalmitis include:^8,21

• Red eyes
• Significant eye pain
• Reduction in vision
• Photophobia
• Swollen eyelids
• Watery eyes

Endophthalmitis is typically treated using antibiotic eyedrops and tablets.²² However, more severe infections may be treated in hospital with antibiotics given through a vein.²²

In some cases, surgery may be required to remove the infected fluid in the back of your eye.²² 

Stye

Symptoms of a stye include:^10,23

• A painful red bump on your eyelid
• Swollen, red eyelids
• Watery eyes
• Crusting along your eyelid
• Photophobia
• Soreness and itching
• A feeling that something is in your eye

You should be able to treat a stye yourself by holding a flannel soaked in warm water against your eye for five to ten minutes a day, two to four times a day. Eye stye treatment can also include painkillers, such as paracetamol and ibuprofen, to relieve the pain.

Uveitis

Symptoms of uveitis include:^11,24

• Eye pain, which may be exacerbated by reading
• Red eyes
• Irritated eyes
• Reduced or blurred vision
• Photophobia
• Swollen conjunctiva
• Changes in the shape of your pupil
• White liquid at the bottom of your eye or in a ring around your iris
• Floaters (rarely)
• Gaps in your vision (rarely)
• Decreased vision (rarely)

If your GP thinks you have uveitis, you will be referred to an ophthalmologist (eye specialist). They will see you within 24 hours and prescribe medication for you to start taking straight away.²⁴

In severe or recurrent cases, you may be offered:²⁴

• Medicines to inhibit your immune system (immunosuppressants) and to reduce inflammation (tumour necrosis factor (TNF) inhibitors)
• Laser treatment (phototherapy)
• Cryotherapy, to temporarily freeze part of the eye
• Surgery on part of your eye

Ocular herpes

Symptoms of ocular herpes include:^13,25

• Eye pain
• Red, irritated eyes
• A feeling that something is in your eye
• Watery eyes
• Swollen eyelids
• Photophobia
• Blurred vision or vision loss
• Inflamed iris
• Blisters, bumps or a rash on your eyelid or the skin around your eye
• Corneal ulcers

If your GP thinks you have ocular herpes, you will be referred to an ophthalmologist (eye specialist). They will see you within 24 hours and prescribe either:²⁴

• an antiviral medicine (e.g. aciclovir), which comes as an eye ointment, eye drops or tablets
• antiviral medicine with steroid eye drops to reduce swelling

Trachoma

Symptoms of trachoma include:^14,26

• Red, irritated eyes
• Swollen eyelids
• Photophobia
• Eye pain
• Blurred vision or vision loss
• Watery eyes
• Discharge from the nose
• Scar tissue on the inside of your eyelids (after repeated infections)
• Misdirection of your eyelashes so they scrape against your cornea (after repeated infections)
• Opaque cornea (after repeated infections)

In the early stages, trachoma can be treated using antibiotics. However, if trachoma recurs, you may be recommended surgery to:

• Change the position of your eyelashes so they don’t rub against your eye
• Replace your cornea

It is extremely important to seek medical care for trachoma as soon as possible, to prevent any loss of vision.

Sources

1. https://my.clevelandclinic.org/health/diseases/25000-eye-infection
2. https://www.aao.org/eye-health/eye-infections
3. https://cks.nice.org.uk/topics/conjunctivitis-infective/background-information/prevalence/
4. https://www.nm.org/conditions-and-care-areas/ophthalmology/eye-infections
5. https://my.clevelandclinic.org/health/diseases/10032-blepharitis
6. https://my.clevelandclinic.org/health/diseases/15071-cellulitis
7. https://my.clevelandclinic.org/health/diseases/24419-dacryocystitis
8. https://my.clevelandclinic.org/health/diseases/24468-endolphthalmitis
9. https://my.clevelandclinic.org/health/diseases/pink-eye-conjunctivitis
10. https://my.clevelandclinic.org/health/diseases/17658-stye
11. https://my.clevelandclinic.org/health/diseases/14414-uveitis
12. https://www.mayoclinic.org/diseases-conditions/keratitis/symptoms-causes/
13. https://my.clevelandclinic.org/health/diseases/ocular-eye-herpes
14. https://www.mayoclinic.org/diseases-conditions/trachoma/symptoms-causes/syc-20378505
15. https://www.nhs.uk/conditions/blepharitis/
16. https://www.hopkinsmedicine.org/health/conditions-and-diseases/keratitis
17. https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/ophthalmology/microbial-keratitis.pdf?rev=e1ac8a7f72d14fc1ab0c091de6da2f92&sc_lang=en
18. https://www.mountsinai.org/health-library/diseases-conditions/orbital-cellulitis
19. https://www.osmosis.org/answers/dacryocystitis
20. https://www.nhs.uk/conditions/conjunctivitis/
21. https://www.ncbi.nlm.nih.gov/books/NBK559079/
22. https://www.moorfields.nhs.uk/eye-conditions/endophthalmitis/diagnosis-and-treatment
23. https://www.nhs.uk/conditions/stye/
24. https://www.nhs.uk/conditions/uveitis/
25. https://www.nhs.uk/conditions/herpes-simplex-eye-infections/
26. https://www.mayoclinic.org/diseases-conditions/trachoma/symptoms-causes/syc-20378505