From the Guidelines
Conjunctival swelling should be treated based on its underlying cause, with a focus on addressing the root cause of the inflammation or infection, as outlined in the conjunctivitis preferred practice pattern 1. When evaluating conjunctival swelling, it is essential to consider the various types of conjunctivitis, including allergic, mechanical/irritative/toxic, and infectious causes, as well as systemic conditions that may contribute to conjunctival inflammation, such as atopy or acute infections like gonorrhea 1. The treatment approach may involve:
- Artificial tears, such as Systane or Refresh Tears, applied 4-6 times daily to provide relief for mild cases
- Cold compresses applied for 10-15 minutes several times daily to reduce swelling
- Antihistamine eye drops, such as ketotifen (Zaditor) or olopatadine (Pataday), used twice daily for allergic conjunctivitis
- Antibiotic drops, like erythromycin or trimethoprim-polymyxin B, applied 4 times daily for 7-10 days for bacterial conjunctivitis It is crucial to note that severe cases or those associated with pain, vision changes, or no improvement after 48 hours require prompt medical attention, as outlined in the conjunctivitis preferred practice pattern 1. Additionally, avoiding eye rubbing and contact lens wear during treatment is important for recovery, and addressing underlying systemic diseases or conditions, such as dry eye or blepharitis, is essential for effective management of conjunctival swelling 1.
From the Research
Causes of Conjunctival Swelling
- Conjunctivitis, or inflammation of the conjunctiva, can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies 2
- Viral conjunctivitis is the most common overall cause of infectious conjunctivitis 3, 4
- Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis 3, 4
- Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help 3
Symptoms of Conjunctival Swelling
- Itching is the most consistent sign in allergic conjunctivitis 3
- Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis 3
- Ocular itching, swelling and tearing are the most frequent symptoms complained by patients with all forms of allergic conjunctivitis 5
- Photophobia and pain are typical of the most severe forms, such as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC), due to the frequent corneal involvement 5
Treatment of Conjunctival Swelling
- Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis 2
- Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work 3, 6
- Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis 3
- Current treatments of allergic conjunctivitis include the use of antiallergic eye drops for mild forms, while recurrences of ocular surface inflammations with corneal involvement in severe forms require the use of topical steroids to avoid visual impairment 5