Bacterial conjunctivitis

Question 1

Pathogens:

Answer 1

H. influenzae

S. pneumoniae

S. aureus

N. gonorrhoea

Others

Question 2

Features

Answer 2

Gritty red eye

Purulent, lids stuck in morning

Starts in one eye, spreads to other

Usually bilateral purulent discharge

Negative fluorescein staining

Question 3

Swab for smear and culture for:

Answer 3

hyperacute or severe purulent conjunctivitis

prolonged infection

neonates

Question 4

Management (mild cases)

Answer 4

Limit the spread by avoiding close contact with others

• use of separate towels
• good ocular hygiene.

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.

Question 5

Management (more severe cases)

Answer 5

Chloramphenicol 0.5% eye drops 1 drop 1–2 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)

Specific organisms:

Pseudomonas and other coliforms: use topical gentamicin and tobramycin

Neisseria gonorrhoea: use appropriate systemic antibiotics

Chlamydia trachomatis: brick red follicular conjunctivitis, use oral azithromycin

Note: never pad a discharging eye