HEENT 15: Bacterial Conjunctivitis

Question 1

Describe the clinical presentation of acute bacterial conjunctivitis.

Answer 1

foreign body sensation, generalized redness, minimal itching and increased secretion, sticky eyelids in morning

Question 2

Describe the clinical presentation of hyperacute bacterial conjunctivitis.

Answer 2

• rapid onset and progression
• purulent discharge, diminished visual acuity, eye tenderness, and swollen lymph nodes
• often caused by N. gonorrhea
• compromised vision
• requires immediate ophthalmic management

Question 3

What are the clinical signs and symptoms of bacterial conjunctivitis?

Answer 3

• purulent discharge
• redness – diffuse
• may have sensitivity to light
• eyelid edema
• glued eyes upon awakening
• absence of pruritus
• mild-moderate pain/stinging
• foreign body sensation

Question 4

Etiology

Answer 4

• children > adults
• contagious
• self-limiting – resolves within 7-10 days

Question 5

What are the causative organisms of conjunctivitis?

Answer 5

common:

• S. aureus
• S. pneumoniae
• H. influenzae
• M. catarrhalis

less common:

• N. gonorrhea – often causes hyperacute bacterial conjunctivitis
• E. coli
• Pseudomonas

Question 6

What are the red flags for referral?

Answer 6

• contact lens wearer, due to the high risk of corneal ulcer
• reduction of visual acuity, blurred vision, halos
• moderate to severe pain or ocular trauma
• rash +/- blisters around eye or redness at the corneoscleral junction, ciliary flush
• photophobia or coloured halos around lights
• severe foreign body sensation that prevents patient from keeping eye open
• corneal opacity
• irregular pupils – fixed, smaller, larger
• severe headache with nausea, vomiting
• bacterial ophthalmic infections in children
• hyperacute bacterial conjunctivitis

Question 7

What is the treatment for bacterial conjunctivitis?

Answer 7

• most cases are self-limiting and will resolve within 7-10 days
• resolution in days with appropriate antibiotic therapy
• watchful waiting in patients with no risk factors or hyperpurulence

Question 8

Topical Antibacterials

Answer 8

• ciprofloxacin
• erythromycin
• fusidic acid
• gatifloxacin
• moxifloxacin
• ofloxacin
• polymyxin B/trimethoprim
• polymyxin B +/- bacitracin +/- gramicidin
• sulfacetamide
• tobramycin

Question 9

What topical antibiotic should be used for mild infection?

Answer 9

polymyxin B/gramicidin

Question 10

What topical antibiotic should be used for moderate to severe infection?

Answer 10

tobramycin

Question 11

What topical antibiotic should be used for severe infection?

Answer 11

fluoroquinolone