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Acute conjunctivitis accounts for over 25% of all eye complaints seen in general practice (
141–3).
Pain and visual loss suggest a serious condition such as glaucoma, uveitis (incl. acute iritis) or corneal ulceration.
Beware of the unilateral red eye—think beyond bacterial or allergic conjunctivitis. It is rarely conjunctivitis and may be a corneal ulcer, keratitis, foreign body, trauma, uveitis or acute glaucoma.
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The five essentials of the history are:
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When examining the unilateral red eye, keep the following diagnoses in mind:
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Of particular concern is orbital cellulitis, which may present as a unilateral swollen lid and can rapidly lead to blindness if untreated. Bacterial, viral and allergic conjunctivitis are common in all children. Conjunctivitis in infants is a serious disorder because of the immaturity of tissues and defence mechanisms.
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Red flags and ‘golden rules’ for red eye
Always test and record vision
Beware of the unilateral red eye
Conjunctivitis is almost always bilateral
Irritated eyes are often dry
Never use steroids if herpes simplex is suspected
A penetrating eye injury is an emergency
Consider an intra-ocular foreign body
Beware of herpes zoster ophthalmicus if the nose is involved
Irregular pupils: think iritis, injury and surgery
Never pad a discharging eye
Refer patients with eyelid ulcers
If there is a corneal abrasion, look for a foreign body
Source: Based on J Colvin and J Reich
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Neonatal conjunctivitis (ophthalmia neonatorum)
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This is conjunctivitis in an infant less than 1 month old and is a notifiable disease. Chlamydial and gonococcal infections are uncommon but must be considered if a purulent discharge is found in the first few days of life. Chlamydia trachomatis usually presents 1 or 2 wks after delivery, with moderate mucopurulent discharge.
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Treatment is with oral azithromycin daily for 3 days and local sulfacetamide.
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N. gonorrhoeae conjunctivitis, which usually occurs within 1 or 2 days of delivery, requires vigorous treatment with intravenous cephalosporins or penicillin and local sulfacetamide drops.
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Trachoma is a chlamydial conjunctivitis that is prevalent in outback areas and in the Indigenous population. C. trachomatis is transmitted by human contact and by flies, esp. where hygiene is inadequate. It is the most common cause of blindness in the world. It is important to start control of the infection in childhood as outlined above.
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For adults (and children >6 kg): azithromycin 1 g (o) once
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Blocked nasolacrimal duct
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