Conjunctivitis: Red-Eye (Diagnose & Treat)

Question 1

What is conjunctivitis?

Answer 1

Viral, allergic or bacterial illness causing red eye, swelling and itch or exudate.

Question 2

What other features are associated with viral conjunctivitis?

Answer 2

Systemic illness
Lymphadenopathy
Sore throat

Question 3

What other features are associated with allergic conjunctivitis?

Answer 3

Acute allergy
Hay fever/atopy
Topical medication

Question 4

What are the most common causes of bacterial conjunctivitis?

Answer 4

Usually staphylococcal

Think neisseria (gonacoccal) and chlamydia in neonates

Question 5

What is the management of viral conjunctivitis?

Answer 5

Supportive

Question 6

What are the symptoms of conjunctivities?

Answer 6

Sore/red eye (even on inside, in blepharitis inside isn’t red)
Discharge (serous if viral, if allergic mucus, if bacterial purulent)
Usually bilateral
Itching (allergic)
Systemic (viral)

Question 7

What are the red flags?

Answer 7

Unilateral (will usually become bilateral)
Recurrent
Neonates (chlamydia or gonacoccal)

Question 8

What are the sings?

Answer 8

All conjunctival blood vessels dilated
Lids stuck together
Bumps on conjunctiva (papillae and follicles)
Cornea should be bright and normal vision (on blinking)

Question 9

What is the management?

Answer 9

Determine type on history
Usually self limiting (1-2 weeks)
Viral is highly infectious

Question 10

What is the treatment?

Answer 10

Hygiene, no towel sharing, no contact lenses
Topical antibiotics
Referral

Question 11

What are the features of a allergic conjunctivitis?

Answer 11

Bilateral conjunctival erythema, conjunctival swelling (chemosis)
Itch
Swollen eyelids
History of atopy and may be seasonal due to pollen or perennial (dust mite/washing powder)

Question 12

What is the management of allergic conjunctivitis?

Answer 12

First-line: topical or systemic anti-histamines

Second-line: topical mast-cell stabilisers e.g. Sodium cromoglicate and nedocromil.

Question 13

What are the features of bacterial conjunctivitis?

Answer 13

Purulent discharge

Eyes may be ‘stuck together’ in the morning

Question 14

What are the features of viral conjunctivitis?

Answer 14

Serous discharge
Recent URTI
Preauricular lymph nodes

Question 15

What topical antibiotic can be used in the treatment of bacterial conjunctivitis?

Answer 15

Chloramphenicol drops

Topical fusidic acid for pregnant women