Eye OTC - Infective Conjunctivitis

Question 1

Define conjunctiva. (1)

Answer 1

Thin protective membrane covering the whites of the eyes and inside eyelids.

Question 2

Define conjunctivitis. (1)

Answer 2

Conjunctiva inflammation:
- Conjunctival blood vessels dilate and eyes appear red.
- Bacterial/viral/allergic causes.

Question 3

Define primary conjunctivitis. (1)

Answer 3

Conjunctiva inflammation only.

Question 4

Define secondary conjunctivitis. (1)

Answer 4

Widespread inflammation affecting other parts of the eye.

Question 5

What are the types of conjunctivitis? (3)

Answer 5

Bacterial: Staphylococcus species, streptococcus pneumoniae, moraxella catarrhalis and gonorrhoea.

Viral: URTI (adenovirus)

Chlamydia (rare): can present as chronic conjunctivitis in newborns and sexually active.

Question 6

What are the symptoms of IC? (5)

Answer 6

Eye discomfort (burning, gritty, minimal pain)
Minimal photophobia (rare)
Eyelids stuck (green/yellow discharge)
Blurry vision (due to discharge)
Hx of close contact

Question 7

What is the differential diagnosis of IC? (3)

Answer 7

Mechanical (eyelashes rubbing surface of eyes, foreign body)

If there’s penetrating eye injury, refer for same day referral to specialist.

Chemical (shampoo, chlorine in swimming pool.)

Question 8

What self-care advice is given to patients presenting with IC? (4)

Answer 8

Self-limiting condition, Hand hygiene, Avoid sharing towels/face cloths, No need to be absent from school.

Eye hygiene

Contact lenses shouldn’t be worn until all symptoms and signs of infection have completely resolved.

Keratitis may complicate conjunctivitis if contact lenses are continued to be work.

Question 9

State the use of ABx for IC. (3)

Answer 9

Chloramphenicol (C/i for 3rd trimester of pregnancy - grey baby syndrome)
Avoid topical ocular ABx
Severe IC: Delayed tx strategy, advise person to initiate topical ABx if symptoms don’t resolve within 3 days. (Fusidic acid 1% eye drops can be used 2nd line.)

Question 10

What is the second line tx for IC? (1)

Answer 10

Chloramphenicol:
- > 2 years to adults.
- Contact lenses shouldn’t be worn during tx: soft lenses for 24 hrs after completion.
- Dose: Apply 1 drop to eye every 2 hrs for first 48 hrs then QDS for up to 5 days.
- See GP if no symptom improvement after 48 hrs or immediately if symptoms worsen.
- S/E: Stinging, burning sensation (temporary) if any blurring of vision occurs don’t drive til vision is clear.
- C/I: Hypersensitivity to chloramphenicol, Hx of myelosuppression or bloo dycrasias.
- Storage: Fridge (initial), once opened keep at room temperature for 28 days.

Question 11

What is the first line tx for IC? (1)

Answer 11

Eyes Bathing:
- Use warm, pre boiled water and cotton pads.
- Each eye should be swabbed once from the inside corner to the outside using each pad once then discard.
- Same pad not used for both eyes.
- Cotton wool (not recommended due to irritation)
- Have own flannel/towel which is washed regularly and never shared.

Question 12

What is the third line tx for IC? (1)

Answer 12

Propamidine eye drops (Golden eye)
Dibromopromanidine Iserionate eye ointment
- > 12 yrs and adults
- No issues of any problems in pregnancy
- Weak evidence based.