Conjunctivitis

Question 1

What are the symptoms of viral conjunctivitis?

Answer 1

• Redness, irritation* (itch, discomfort)
• Watery discharge
• Often bilateral – starts in one eye then spreads to the fellow eye subsequently
• **A/w URTI symptoms or positive contact history -> must elicit in hx

Question 2

What are the signs of viral conjunctivitis?

Answer 2

• Generalised injection +/- chemosis (swelling/oedema of conjunctiva)
• Evert lids: follicles, pseudomembranes (yellowish membranes of coagulated discharge adherent to palpebral conjunctiva)
• Preauricular lymphadenopathy

Question 3

what is the management of viral conjunctivitis?

Answer 3

• Self-resolving in 2-4 weeks
• Symptomatic treatment w topical lubricants
• Advise hand hygiene & contact precautions (highly contagious via respiratory or ocular secretions), i.e. stay home from school/work
• Nummular keratitis – topical steroids

Question 4

What are the symptoms of bacterial conjunctivitis?

Answer 4

• Redness

- *Purulent discharge

Question 5

What are the signs of bacterial conjunctivitis?

Answer 5

• Very injected or chemotic eye
• Matting of lids and lashes (due to discharge)
• Evert lids: follicles, papillae, pseudomembranes
• Corneal infiltrates or thinning in severe cases

Question 6

what are the causative organisms for bacterial conjunctivitis?

Answer 6

• Simple bacterial: usual pathogens (Staph, Strep, HI, Pseudo)
• Hypercaute bacterial: **gonococcal and Chlamydia -> both require screening for other STDs

Question 7

what is the management of simple bacterial conjunctivitis?

Answer 7

• Swab for G stain & c/s
• Topical BSA, e.g. cefazolin, levofloxacin
• Copious lubricants (flush out organism)

Question 8

What is the management of gonococcal conjunctivitis?

Answer 8

• Admission
• URGENT conjunctival swab for G stain & c/s -> if G- diplococci confirmed, topical penicillin AND systemic penicillin or ceftriaxone
• Irrigation
• Monitor for complications (corneal ulceration, perforation)
• Contact tracing required – notifiable disease

Question 9

what is the presentation of someone with chlamydial conjunctivitis?

Answer 9

• Chronic/subacute (2weeks+) follicular conjunctivitis +/- corneal involvement
• Discharge may be mucopurulent/watery
• Often occurs in conjunction with urethritis (but frequently asymptomatic in male

Question 10

what is the management of someone with chlamydial conjunctivitis?

Answer 10

• Conjunctival scraping (for immunofluorescence scan, PCR; needed because Chlamydia is intracellular, so tissue cells are required)
• Systemic abx (azithro/doxy) + topical abx (erythro/tetra) for relief of ocular sympt

Question 11

what are the symptoms of someone with allergic conjunctivitis?

Answer 11

• Red eye
• **Itch – prominent symptom
• Minimal watery or mucoid discharge – tearing, ‘stringy’ discharge
• History of other atopic conditions e.g. allergic rhinitis, eczema, asthma
• Also note allergen exposure, associated rhinorrhoea in recent hx

Question 12

what are the signs of someone with allergic conjunctivitis?

Answer 12

• Conjunctival injection +/- pinkish chemosis
• Evert lids: micro and macro papillae on lower and upper eyelid conjunctiva
• Corneal involvement (in vernal keratoconjunctivitis)

Question 13

what is the management of someone with allergic conjunctivitis?

Answer 13

• allergen avoidance
• preservative free lubricants
• antihistamines, mast cell stabilizers
• topical steroids (if severe): avoid long term use
• Steroid-sparing immunomodulators eye drops (e.g. cyclosporine, tacrolimus)
• Systemic antihistamines
• Children age < 8 years (i.e. VKC) are treated more aggressively, due to risk of amblyopia (2’ to poor vision from poor ocular surface)