Conjunctivitis

Question 1

Conjunctivitis - background (1)

Answer 1

1. Conjunctivitis = inflammation of lining of eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation or medicines

Question 2

Neonatal conjunctivitis - causes + summary (3)

Answer 2

1. ‘Sticky eyes’
   a. Common in neonatal period starting from 3rd to 4th day
   b. Swabs usually negative for significant pathogens
   c. Simple cleaning measures usually sufficient
   d. Bacterial infection with either Staphylococcus aureus, Pseudomonas aeruginosa or streptococcal pathogens can occur
   e. Topical abx ointment indicated, e.g. neomycin
2. Gonococcal conjunctivitis
   a. Suspect if purulent discharge with swelling of eyelids in first 48h of life
   b. Discharge should be Gram-stained urgently + cultured
   c. Start tx immediately, as permanent loss of vision can occur. Give IV abx, e.g. cephalosporin + clean eye frequently
3. Chlamydial conjunctivitis
   a. Usually presents at end of first week of life. Purulent discharge + swelling of eyelids
   b. Dx established by specific monoclonal antibody test performed on conjunctival secretions (immunofluorescent staining)
   c. Two week course of oral erythromycin or topical tetracycline

Question 3

Childhood conjunctivitis - causes (3)

Answer 3

1. Bacteria (e.g. Gram positive cocci, Haemophilus influenzae)
2. Virus (e.g. adenovirus)
3. Allergic reaction

Question 4

Viral conjunctivitis - sx

Answer 4

1. Moderate discomfort
2. Moderate epiphora (watering), mild to moderate erythema
3. Mild discharge

Question 5

Bacterial conjunctivitis - sx

Answer 5

1. Moderate to severe discomfort
2. Moderate epiphora, moderate to severe erythema
3. Copious discharge

Question 6

Allergic conjunctivitis - sx

Answer 6

1. Excessive blinking and eye rubbing
2. Mild to moderate epiphora, mild erythema
3. Watery discharge

Question 7

Conjunctivitis - dx

Answer 7

Clinical

- Note: microbiological ix not usually indicated

Question 8

Conjunctivitis - mx (3)

Answer 8

1. Bacterial (1, with 3 types of abx) = broad-spectrum topical antibiotic (e.g. chloramphenicol, framycetin sulphate, neomycin)
2. Viral (2) = eye toilets, prevention of sharing towels in family
3. Allergic (3) = cold compresses if mild; topical eye drop mast cell stabilisers helpful for more severe symptoms; topical steroid preparations for persistent/severe cases (under ophthalmologist supervision only due to side effects - cataract, glaucoma, keratitis)