Makindo Medical Notes

Allergic and infective conjunctivitis are common conditions. If symptoms worsen or persist beyond ten days, stop all drops and seek an ophthalmology opinion. Infective conjunctivitis is usually self-limiting and does not routinely require antibiotics.

About

• Ask about contact lens usage.
• The conjunctiva is a thin layer of tissue covering the front of the eye.

Aetiology

• Viral: Adenovirus, enterovirus, occasionally herpes simplex.
• Bacterial: Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae.
• Allergic: Hay fever, allergy to chloramphenicol.
• Rare Causes: Membranous conjunctivitis (e.g., cicatricial pemphigoid, Stevens–Johnson syndrome).
• Chronic: Trachoma leading to scarring.

Clinical Features

• Self-limiting in 7-10 days in most cases.
• Severe cases: Red or pink eyes, sticky discharge.
• Bacterial: Glued lids on waking.
• Viral: Often a history of previous episodes.
• Allergic: Itching, often related to hay fever or allergy to medications like chloramphenicol.
• Severe STD-related Conjunctivitis: Gonorrhoea or chlamydia, presenting with prolonged mucopurulent discharge, requiring swabs, contact tracing, and treatment.

Investigations

• Culture swabs if symptoms persist.

Management

• Allergic Conjunctivitis:
  • Cool compresses as needed.
  • Ocular lubricating drops, gels, or ointments (preservative-free), used four times daily (available OTC).
  • Consider systemic or topical antihistamines or mast cell stabilizers.
• Infective Conjunctivitis:
  • No treatment required for the first 3 days in adults (likely viral).
  • Clean eyes with cool, clean water and use lubricating drops.
  • Avoid contact lens use during treatment.
• Purulent Conjunctivitis:
  • Chloramphenicol 0.5% eye drops every 2 hours for 2 days, then every 4 hours for 48 hours after symptom resolution.
• Ophthalmia Neonatorum:
  • Urgent hospital review for neonates with symptoms.
  • Chloramphenicol 0.5% eye drops and 1% eye ointment until 2 days after symptoms resolve.
• Red Flags:
  • Contact lens wearers: Always ask and refer urgently to ophthalmology for suspected corneal ulcers.
  • Do not administer antibiotics prior to corneal culture to avoid interference.
  • Low threshold for referral in severe cases.

References

• ACI Eye Emergency Manual