Makindo Medical Notes

If symptoms worsen or persist beyond ten days, stop all drops and seek an Ophthalmology opinion. Infective conjunctivitis is a common self-limiting condition and does not routinely require antibiotics

About

• Ask about contact lens usage
• Conjunctiva: thin layer of tissue that covers the front of the eye

Aetiology

• Adenovirus, enterovirus, occasionally herpes simplex)
• Bacterial: Streptococcus pneumoniae, staphylococcus aureus and Haemophilus influenzae.
• Allergic: Hayfever, allergy to chloramphenicol
• Rare: membrane (cicatricial) pemphigoid or Stevens–Johnson syndrome
• Trachoma can cause scarring

Clinical

• Usually self-limiting in 7-10 days
• Severe case "Red eye" Pink eyes, sticky, discharge
• Bacterial - glued lids on waking
• Viral - usually a history of previous episodes
• Allergic - itching is common due to hay fever or allergy to chloramphenicol, which is commonly used to treat conjunctivitis
• Severe conjunctivitis with STD: gonorrhoea. If prolonged mucopurulent discharge (chlamydia) and require swabs, contact tracing and treatment

Investigations

• Culture swabs if persists

Management

• Allergic: Cool compresses as required. Ocular lubricating drops, gels or ointments (preservative free) qid available over the counter. Consider systemic antihistamine or topical antihistamine/mast-cell stabilise
• Infection: Usually no treatment required at least for first 3 days in adults; viral cause most likely (adenovirus, enterovirus, occasionally herpes simplex). Bath eyes with cool clean water, using lubricating drops, using moist cotton wool to clean the lids, and abstaining from contact lens use.
• Purulent conjunctivitis: Chloramphenicol 0.5% eye drops every 2 hours for 2 days and then 4 hourly for 48 hours after resolution of symptoms
• Ophthalmia neonatorum in a neonate; this does not refer to a simple sticky eye in a neonate and requires urgent review in the hospital. Persisting symptoms consider Chloramphenicol eye drops 0.5% and Chloramphenicol eye ointment 1%. Continue until 2 days after symptoms resolve.
• Red flag: Contact lens wearer (always ask) If suspected refer urgently to Ophthalmology if suspected corneal ulcer, and do not give antibiotics in the interim as this may interfere with a subsequent corneal culture. Have a low threshold for referral

References

• Eye Manual