Golden Eye science summary

Return to eye infection resources

Golden Eye science summary

- Dr Nisa Aslam & Pharmacist Sultan Dajani

Introduction

Superficial mild eye infections such as conjunctivitis, styes and blepharitis are very common. Poor immune function can lead to any type of infection, including an eye infection. But many eye infections are caused by poor eye hygiene, including poor management of contact lenses.

Rubbing and touching eyes when your hands are not clean, using contaminated eye make-up, leaving make-up on overnight or keeping eye make-up for longer than six months can increase the risk of developing an eye infection. Or simply being in contact with someone else who has an eye infection can also increase your risk.

Though it may be something we don’t think about, good eye hygiene is very important. Sharing towels and face flannels, as well as pillows, should be avoided. Washing the same with hot water and detergent is vital to help prevent eye infections and maintain eye hygiene should an eye infection occur.

Any superficial eye infection should be treated immediately. Eye infections can become serious so it’s important to nip them in the bud. Golden Eye® has a range of eye drops and eye ointments that can be used to treat superficial eye infections like conjunctivitis (red eye), styes and blepharitis (infection of the eyelash follicles or eyelids).

It is important to differentiate between these products and their uses. Golden Eye® Eye Drops (propamidine isethionate) and Golden Eye® Eye Ointment are used to treat conjunctivitis and blepharitis, while Golden Eye® Eye Ointment (dibrompropamidine isethionate) can also be used to treat a stye. These two products contain dimidines which are antiseptics not antibiotics. They stop bacteria growing and multiplying. By contrast, a third Golden Eye® product – Golden Eye® Antibiotic Eye Ointment contains the antibiotic chloramphenicol which should be reserved for acute bacterial conjunctivitis.

The non-antibiotic Golden Eye® Eye Drops and Eye Ointment should be chosen first line as limiting the use of an antibiotic containing product may help to reduce bacterial resistance to antibiotics. These two products therefore have a key place in the management of superficial eye infections.

To end on a note of caution, our eyes are incredibly important to us. Eye infections can be very serious and if anyone has pain in the eye or blurred vision or has sustained an injury to the eye, medical advice should be sought without delay. And if any superficial eye infection does not improve within 2 days of treating it, a doctor’s advice should be sought.

Golden Eye® is a range of easy to use topical eye treatments (eye drops and eye ointments) for the most common eye complaints and bacterial infections including conjunctivitis, styes and blepharitis.

Eye infections are quite common, and can be caused by:

• Contact with someone who has already got an eye infection
• Poor immune function – e.g. after a cold or flu
• Touching or rubbing eyes when the fingers are not clean
• Anything that drives rubbing of the eyes like not getting enough sleep
• Using contaminated eye makeup
• Leaving eye makeup on overnight

Eye infections are also caused by poor management of contact lenses including:

• improperly cleaned contact lenses
• touching contact lenses before washing hands
• wearing contact lenses while sleeping
• reusing disposable contact lenses
• using contact lenses after they’ve expired

Conjunctivitis

What is it?

Conjunctivitis is a common eye condition resulting in red eyes. It is described as inflammation of the conjunctiva. The conjunctiva is a membrane or thin layer of tissue covering the white of the eye (sclera). Conjunctivitis can be caused by infection, allergy or irritation. It is sometimes referred to as ‘red eye’.

Infectious conjunctivitis can be caused by both bacteria and viruses, of which viral conjunctivitis is the most common. Viruses responsible for viral conjunctivitis include, in most cases, adenovirus and occasionally herpes simplex or herpes zoster viruses. The main bacteria responsible for bacterial conjunctivitis include Haemophilus influenza, Streptococcus pneumoniae and Staphylococcus aureus.

Both types of conjunctivitis can often be found alongside other signs and symptoms of a respiratory tract infection such as a cold or a cough.

Note: there are serious types of red-eye which are usually more painful. If eye pain and change in vision are significant features of red eyes the person should visit their GP or optometrist.

Signs and symptoms

The main symptoms of conjunctivitis are firstly redness or pinkness due to dilation of the blood vessels over the sclera caused by the infection, allergy or irritation. Secondly, discharge. The cells of the conjunctiva on the inside of the eye lids produce mucus, and the glands produce tears. When inflamed, more mucus and more tears are produced leading to a discharge.

The discharge is sticky and purulent in bacterial infections and watery in viral infections. A systematic review found that a sticky discharge with sticking together of the eyelids on waking and a lack of itching were more likely associated with bacterial conjunctivitis than with other types.¹ A gritty sensation in the eye is a common symptom of all types of conjunctivitis but itching with a watery discharge is most commonly associated with allergic conjunctivitis (e.g. in hay fever or pet allergy)

Conjunctivitis can affect one eye at first, but usually affects both eyes after a short time. It can occur when you are run down or your immune system is low, which is why many people get conjunctivitis when they have a cold or flu. Conjunctivitis is highly contagious and can be spread easily through contact with the discharge from the eyes. This is why the condition often starts in one eye and then spreads to the other and also spreads easily from person to person.

Summary: symptoms of conjunctivitis

• The white of the eye may look red or pink
• Eyelids may be inflamed and sore
• Eye may feel gritty and itchy
• White or yellow sticky discharge from the eye
• Eyelids may be stuck together in the morning
• Discharge on the eyelashes

Treatment

Conjunctivitis should be treated quickly. Use cooled water which has been boiled to wipe off any crusts with a clean cotton wool pad (one for each eye).

For a mild infection use Golden Eye® Eye Drops and/or non-antibiotic Golden Eye® Eye Ointment. These products contain ‘dimidines’ which belong to a group of antiseptics. They prevent bacteria growing and multiplying (see mechanism of action below).

If used alone, the eye drops OR the eye ointment should be used four times a day. If using a combination of both products, the eye drops should be used four times daily and, and the ointment can be used once daily at bedtime.

For acute bacterial conjunctivitis, Golden Eye® produce an antibiotic eye ointment containing the antibiotic chloramphenicol.

How to stop infectious conjunctivitis from spreading

• Wash hands regularly with warm soapy water
• Wash pillowcases and face cloths in hot water and detergent
• Cover mouth and nose when sneezing and put tissue in the bin
• Do not share towels and face cloths
• Do not rub eyes
• Do not wear contact lenses until the eyes are better

Stye

What is it? 

Styes develop when a gland or a follicle at the edge of the eyelid becomes infected. Resembling a ‘pimple’ on the eyelid, a stye is filled with pus. Styes can grow on the inside or outside of the lid.

• External styes. Most external styes start in an eyelash follicle. Occasionally, they start in an oil (sebaceous) gland. They are located on the outside edge of the eyelid.
• Internal styes. Most of these begin in an oil (meibomian) gland within the eyelid tissue (meibomian gland). They push on the eye as they grow, so they tend to be more painful than external styes. They are less common than external styes.

Most styes are caused by Staphylococcus, a type of bacteria that live on the skin and are normally harmless. When the bacteria are transferred to the eye and become trapped in a gland or hair follicle, they cause an infection.

Signs and symptoms

Apart from the appearance of the pus-filled pimple, styes are associated with symptoms such as:

• eyelid swelling and redness
• yellowish discharge
• sensitivity to light
• feeling like there’s something in the eye
• felling painful or tender when blinking
• a gritty feeling in the eye
• the eye may be red and watery, but vision should not be affected
• a crust that forms on the edge of the eyelid.

Styes usually only affect one eye, although it is possible for both eyes to be affected.

The key to successful management is to get the infection site to form a ‘point’. A warm compress should help the point to burst on its own to help relieve the discomfort.

Treatment: Styes

Never squeeze or try to pop a stye. It can spread the infection to the rest of the eyelid. Makeup and/or contact lenses should not be used until the stye has gone.

The key to successful management of a stye is to get the infection site to form a ‘point’. A warm compress should help the point to burst on its own to help relieve the discomfort.

An OTC product such as Golden Eye^® 0.15% w/w Eye Ointment (dibrompropamidine isethionate) can be recommended. This product does not contain an antibiotic and may help to reduce the potential increase in bacterial resistance to antibiotics.

Blepharitis

What is it? 

Blepharitis is the medical term for inflamed eyelids. The eyelids become infected with bacteria.

Blepharitis can be caused by a type of bacteria that lives on the skin or by a skin condition, such as atopic dermatitis.

Signs and symptoms

Characteristic symptoms of blepharitis are itchy, stinging and sticky eyes. The symptoms and signs are like conjunctivitis and the two conditions are often confused. In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning. Most people experience repeated episodes followed by periods with no symptoms.

Summary: symptoms of blepharitis

• crusting, swelling and redness of the eyelids
• dryness of the eye
• a gritty feeling and burning sensation in the eye
• tiny flakes on the eyelids similar to fine dandruff
• sensitivity to light
• blurred vision
• loss of eyelashes or in-growing eyelashes
• styes
• small ulcers on the eyelids

Treatment

Management of blepharitis involves good eyelid hygiene:

• eye makeup must be avoided
• soak the closed eyelids with a flannel or warm cotton wool pad, then clean the eyelids by wetting a cloth or cotton bud with cleanser (e.g. baby shampoo diluted 1:10 or bicarbonate solution) and wipe along the lid margins

For blepharitis, use Golden Eye® Eye Drops and/or non-antibiotic Golden Eye® Eye Ointment. These products contain substances called ‘dimidines’ which belong to a group of chemicals known as antiseptics. They prevent bacteria growing and multiplying (see mechanism of action below).

If used alone, the eye drops OR the eye ointment should be used four times a day. If using a combination of both products, the eye drops should be used four times daily during the day, and the ointment can be used once daily at bedtime.

Golden Eye® In more detail

Golden Eye® Eye Drops and Golden Eye® Eye Ointment

Golden Eye^® Eye Drops contain propamidine isetionate, whilst Golden Eye® Eye Ointment contains dibrompropamidine isetionate.

Both these compounds belong to a group of medicines called antiseptics, part of the aromatic diamidine group of compounds which possess bacteriostatic properties against a wide range of organisms. This means they stop bacteria from growing and multiplying rather than killing them. They control the number of bacteria causing the eye infection, so helping to relieve symptoms. The remaining bacteria die or are killed by your body’s immune system.

Diamidines exert antibacterial action against bacteria such as pyrogenic cocci, antibiotic-resistant staphylococci and some Gram-negative bacilli. Of relevance to eye infections the activity of the diamidines is retained in the presence of organic matter such as tissue fluids, pus and serum.

Used as topical eye treatments, the diamidines (propamidine isetionate and dibrompropamidine isetionate) present in Golden Eye® Eye Drops and Golden Eye® Eye Ointment:

• Offer a first-line alternative to antibiotic treatments such as chloramphenicol
• May help to reduce the potential increase in bacterial resistance to antibiotics
• Offers the flexibility and convenience of both eye drops and eye ointment for day and night- time use

Golden Eye® Antibiotic 1% Eye ointment

Golden Eye® Antibiotic 1% Eye Ointment contains chloramphenicol. Chloramphenicol is a broad- spectrum antibiotic, which means it is effective

against infections caused by a wide variety of bacteria. Chloramphenicol works by preventing

bacteria from producing proteins that are essential to them. Without these proteins the bacteria

cannot grow, replicate and increase in numbers.

Chloramphenicol controls the numbers of bacteria causing the infection, and the remaining bacteria die or are killed by the body's immune system. This clears up the infection. Putting the medicine into the eye allows it to act directly on the bacteria causing the infection.

Golden Eye® 1% Antibiotic Eye ointment is suitable for children from the age of 2 years and for adults.

Last word

Our eyes are incredibly important, and we should never take them for granted. In direct contact with the outside world – despite their incredible toughness – eyes can become infected. This can occur due to poor eye hygiene, poor immune function or contact with someone else with an eye infection.

Superficial eye infections such as conjunctivitis, styes and blepharitis should be managed without delay.

Excellent eye hygiene is vital. The Golden Eye® range of drops and ointments are effective treatments for superficial eye infections. Care should be taken to choose the most appropriate preparations.

Golden Eye® Eye Drops and Golden Eye® Eye Ointment are indicated for conjunctivitis and blepharitis. Either can be used on their own four times a day or in combination with the drops used four times a day and the ointment at night. Golden Eye® Eye Ointment is also suitable for treating styes.

Golden Eye® Antibiotic Eye Ointment should be reserved for use in acute bacterial conjunctivitis. Reserving antibiotic use for more acute superficial infections may help to play a part in limiting the spread of bacterial resistance.

Return to eye infection resources