Conjunctivitis

Question 1

What is the pathophysiology of all the conjunctivitis-es

Answer 1

Viral: adenovirus infections most common, followed by herpes simplex
Bacterial: often caused by staphylococcal species, followed by streptococcus. Neisseria gonorrhoeae or chlamydia will cause more serious infections
Allergy: peak in spring/summer

Question 2

Compare and contrast the presentation of the conjunctivitis-es– itching, discharge, presence of fever/sore throat and lymphadenopathy

Answer 2

Viral: minimal itching, watery discharge, presence of fever/sore throat and lymphadenopathy
Bacterial: minimal itching, purulent discharge, sometimes fever/sore throat, uncommon to have lymphadenopathy
Allergic: severe itching, watery discharge, no fever/sore throat, no lymphadenopathy

Question 3

What are red flags when assessing for conjunctivitis?

Answer 3

Contact lens wearer
Vision changes
Moderate-sever pain or ocular trauma
Severe or hyperpurulent discharge
Rash
Severe headache
Bacterial conjunctivitis in children

Question 4

What are non-pharmacological treatments for conjunctivitis

Answer 4

Viral/allergic: cold compress
Bacterial: warm compress
Sterile saline irrigation/eye wash
Eyelid wipes for blepharitis
Stop wearing contact lens and seek medical advice

Question 5

What are pharmacological treatments for viral conjunctivitis

Answer 5

Usually self limiting, no proven treatment

Can use supportive treatment such as ocular lubricants or decongestants

Question 6

What are pharmacological treatments for bacterial infections?

Answer 6

Self-limiting within 7-10 days
OTC: 
Polymyxin B gramicidin eye/ear drops. Refer if no improvement after 2 days
Rx:
Erythromycin 0.5% 
Fusidic acid 1%
Trimethoprim/polymyxin B
Tobramycin 0.3%
Fluoroquinolones (-floxacins): for more serious infections in those >1y

Question 7

What are pharmacological treatments for allergic blepharitis?

Answer 7

First line is to remove allergens
OTC:
Artificial tears/saline
Antihistamine/decongestant gtts short term
Mast cell stabilizers (sodium cromoglycate 2%), must be used regularly
Rx:
Antihistamine/mast cell stabilizers (ketotifen, olopatadine)
Mast cell stabilizers (lodoxamine)

Question 8

When can children return to school after getting conjunctivitis?

Answer 8

Viral: until there’s no more ocular discharge
Bacterial: 24 hours after starting treatment