Conjunctivitis
- Diffuse hyperaemic of tarsal or bulbar conjunctivae – conjunctival vessels enlarge – do not cross onto cornea/iris
- Absence of pain, good vision, clear cornea
- Discharge, gritty/sandy sensation
- REFER if pain, reduced vision or photophobia
| Allergic conjunctivitis | |
| Age | Children or adults |
| Aetiology | Local response to an allergen, including: – seasonal (typically spring and autumn) – perennial – contact hypersensitivity reactions (eg preservatives in eye drops, contact lens solutions). |
| Clinical features | In seasonal and perennial conjunctivitis- symptoms are usually bilateral. The primary diagnostic symptom – itch with watery eyes – usually bilateral – Follicular “cobblestone pattern” |
| Treatment | Treat as allergic rhinitis – oral antihistamines – intranasal corticosteroids – Saline eye drops/washes for symptoms If not responsive 🡪 medicated eye drops – Combination – azelastine, ketotifen, olopatadine are recommended as first line – OTC – Antihistamines – rapid relief – levobastine – Mast cell stabilisiers – cromoglycate, lodoxamide – delayed onset 2 weeks but longer term relief Only use anti-inflammatory or steroid drops if recommended ophtal Vasoconstrictor eye drops not recommended – can lead to – overuse/rebound Discontinue contact lenses, cool compresses |
| Viral conjunctivitis | |
| Age | More common in adults |
| Aetiology | Frequently associated with a viral upper respiratory tract infection and preauricular lymphadenopathy. Most commonly caused by adenovirus. |
| Clinical features | Common symptoms: – conjunctival injection (red eye) – watery or mucoid discharge – irritation – initially unilateral but often become bilateral |
| Treatment | – Symptomatic treatment – cold compresses several times a day – lubricant eye drops – hygiene measures to reduce the spread of infection – Avoid the use of topical corticosteroids without advice from an ophthalmologist – There is no role for topical antibiotics such as chloramphenicol. OphthaL REFERRAL IF significant pain,reduced vision,photophobia. |
| Bacterial conjunctivitis | |
| Age | More common in children |
| Aetiology | Can be Primarysecondary to nasolacrimal duct obstruction Swab if hyperacute or severe, prolonged, neonatesPathogens include – Staphylococcus aureus – streptococcus pneumonia – Haemophilus influenzae – Chlamydia trachomatis – Neisseria gonorrhoeae – Neisseria meningitidis — can precede or accompany systemic disease 🡪 treatment is as for invasive meningococcal disease—see Neisseria meningitidis (meningococcal) meningitis. |
| Clinical features | Symptoms have a rapid onset. Usually unilateral but may be bilateral. Common symptoms: – conjunctival injection (red eye) – purulent discharge – crusting of the eyelids. |
| Treatment | Systematic reviews have found that topical antibiotics confer modest benefits in improving symptom resolution. However, most cases resolve within 7 days without treatment – Chloramphenicol 0.5% eye drops, 1 drop into the affected eye, four times a day for up to 7 days OR – Framycetin 0.5% eye drops, 1 drop into the affected eye, four times a day, for up to 7 days. – Both chloramphenicol and framycetin can cause contact hypersensitivity reactions, which may be severe. – Aminoglycoside (eg gentamicin, tobramycin) and quinolone (eg ciprofloxacin, ofloxacin) eye drops are not recommended for empirical treatment. – severe or worsening symptoms 🡪 exclude Keratitis 🡪 Prompt referral to an ophthalmologist – If conjunctivitis persists, perform bacterial and viral conjunctival swabs to identify atypical or resistant organisms |
| Chlamydial conjunctivitis | |
| Clinical features | usually occurs in neonates, and in adults with exposure to sexually transmitted infections Infection in a neonate, infant or child may reflect : – mother-to-child transmission – accidental transmission – sexual abuse Refer patients with chlamydial conjunctivitis who have pain, photophobia or reduced vision |
| Treatment | Systemic treatment is necessary. For adults and children older than 1 month, use: – Azithromycin 1 g (child: 20 mg/kg up to 1 g) orally, as a single dose. – For neonates, use: azithromycin 20 mg/kg orally, daily for 3 day |
| Gonococcal conjunctivitis | |
| Clinical features | is an ophthalmic emergency 🡪 can cause ulceration and perforation of the cornea acute onset of copious, purulent discharge Infection in a neonate, infant or child may reflect – mother-to-child transmission – accidental transmission – sexual abuse |
| Treatment | start empirical antimicrobial therapy immediately Refer immediately to an ophthalmologist if corneal opacity develops cefotaxime 1 g (child: 50 mg/kg up to 1 g) intramuscularly or intravenously, as a single dose PLUS azithromycin 1 g (child: 20 mg/kg up to 1 g) orally, as a single dose |