Conjunctivitis

BACTERIAL CONJUNCTIVITIS

Pathogens: H. influenzae, S. pneumoniae, S. aureus, N. gonorrhoeae, others

Features

• Gritty red eye

• Purulent, lids stuck in morning

• Starts in one eye, spreads to other

• Usually bilateral muco-purulent discharge usually without lymphadenopathy

• Negative fluorescein staining

Swab for smear and culture for:

• hyperacute or severe purulent conjunctivitis

• prolonged infection

• neonates

Management (mild cases) Limit the spread by avoiding close contact with others, use of separate towels and good ocular hygiene.

Mild cases may resolve with saline irrigation of the eyelids and conjunctiva but may last up to 14 days if untreated. An antiseptic eye drop such as propamidine isethionate 0.1% (Brolene) 1–2 drops 6–8 times hrly for 5–7 d can be used. Cooled black tea may be effective.

Management (more severe cases)

• Chloramphenicol 0.5% eye drops 1–2 drops 2 hrly for 2 d, decrease to qid for 5–7 d ± chloramphenicol 1% eye ointment nocte or

• Framycetin 0.5% eye drops 1–2 hrly for first 24 hrs, decreasing to 8 hrly until discharge resolves (up to 7 d)

Note: Never pad a discharging eye.

Specific organisms:

• Pseudomonas and other coliforms: use topical gentamicin and tobramycin

• Neisseria gonorrhoeae: use appropriate systemic antibiotics

• Chlamydia trachomatis: brick red follicular conjunctivitis, use oral azithromycin

VIRAL CONJUNCTIVITIS

Features

• Very contagious (examine with gloves)

• Usually due to adenovirus

• Tends to occur in epidemics (pink eye)

• 2–3 wk course

• Starts in one eye, spreads to other

• Scant watery discharge

• May be tiny pale lymphoid follicles

• Pre-auricular lymph node

Can perform viral culture and serology to predict epidemics.

Treatment

• Limit cross-infection by appropriate rules of hygiene and patient education; infectious until redness and weeping resolve (usually 10–12 d)

• Treatment is symptomatic (e.g. cool compress and topical lubricants—artificial tear preparations) or salt water bathing

• Do not pad; avoid bright lights

• Watch for secondary bacterial infection

• Avoid corticosteroids—prolong the infection

PRIMARY HERPES SIMPLEX INFECTION

• A follicular conjunctivitis

• 50% have lid or corneal ulcers (diagnostic)

• Dendritic ulceration with fluorescein (in some)

Treatment of herpes simplex keratitis

• Attend to eye hygiene

• Aciclovir 3% oint, 5 times/d for 14 d or for at least 3 d after healing

• Atropine 1% 1 drop, 12 hrly, for the duration of treatment will prevent reflex spasm of the pupil (specialist supervision)

• Debridement by a consultant

ALLERGIC CONJUNCTIVITIS

Includes vernal (hay fever) conjunctivitis and contact hypersensitivity reactions.

Treatment—vernal (hay fever) conjunctivitis Tailor treatment to the degree of symptoms. Antihistamines (oral) may be required but symptomatic measures usually suffice.

• Use sodium cromoglycate 2% drops, ...