Conjunctivitis

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ALLERGIC CONJUNCTIVITIS

CLINICAL DESCRIPTION

Condition characterized by conjunctival inflammation caused by airborne allergens. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Itchy eyes, excessive tearing, watery/non-purulent discharge, burning/foreign body sensation, conjunctival hyperaemia (redness/pink eye)
  • Eyelid oedema
  • Conjunctival papillae ranging from small to large or ‘cobblestone’ on the tarsal conjunctiva (seen on everting eyelid) depending on severity of condition. Usually bilateral, but one eye can be affected more than the other. Associated with other allergic conditions such as allergic rhinitis, asthma.
  • A positive family history of atopic disease may be present. 

TREATMENT

  • Avoid triggers/allergens when identified. Patients should not rub their eyes

Mild disease:

  • Cool compresses over the eyelids to reduce oedema
  • Artificial tears, Hypromellose or Viscotears 6 hourly or 8 hourly

Moderate disease

  • Mast cell stabilizers e.g., Sodium Cromoglycate eye drops 6 hourly
  • Antihistamines e.g., Olopatadine eye drops

Severe Disease 

  • Treat as moderate disease with a short course of low potent steroid eye drops such as Fluorometholone eye drops 0.1% EVERY 8HRS, otherwise Dexamethasone eye drops 0.1% 8 hourly may be used

Topical steroids should only be used for a maximum of 2 weeks

 

BACTERIAL CONJUNCTIVITIS

CLINICAL DESCRIPTION

An acute conjunctivitis that develops secondary to a bacterial infections. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Pinkness or redness of the eye
  • Burning, itching
    • A sensation of grittiness or mild pain or discomfort in the eye.
    • Thick, sticky discharge from the eye and swollen eye lids.
    • It is usually bilateral but may be unilateral. 

Treatment 

  • Eyelids to be cleaned of discharge before using topical antibiotics.
  • Eye drops options include:
    • Chloramphenicol 0.5%, 
    • Ciprofloxacin 0.3%,
    • Ofloxacin 0.3%,
    • Moxifloxacin 0.5% 

Note: Eye ointments such as Chloramphenicol and Tetracycline provide higher concentrations for longer periods than drops but inappropriate for day use because of blurred vision.

 

OPTHALMIA NEONATRUM (ON)

CLINICAL DESCRIPTION

Conjunctivitis developing within first month after birth because of infection transmitted from mother to infant during delivery. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Chlamydia ON
    • Most common. Occurs 5 - 14 days after birth. May be unilateral or bilateral.
    • Red eye, watery discharge, lid oedema, pseudo membranes (depending on severity)
  • Gonococcal ON
    • Occurs 2 - 7 days after birth. Almost always bilateral.
    • Severe and copious purulent discharge, red eyes, marked lid oedema and chemosis,
  • Herpetic ON
    • Occurs 1 - 14 days after birth
    • Periocular vesicles, lid oedema, moderate redness of the eyes.

TREATMENTOphthalmia neonatorum may have both ocular and systemic complications; therefore, it should be treated systemically.

  • Chlamydia ON: Erythromycin suspension 50mg/kg/day 6 hourly for 14 days with Tetracycline eye ointment every 6hrs
  • Gonococcal ON: Ceftriaxone 50mg/kg/24hr (maximum 125mg) IV or IM with tetracycline eye ointment every 6hrs for 2 weeks. Frequent eye irrigation with sterile isotonic saline is recommended as adjunct therapy.
  • Herpetic ON: Acyclovir 45-60mg/kg in 3 divided doses for 14 days and topical Acyclovir 5 times daily

PROPHYLAXIS

  • Given within 24 hours after birth as a single dose.
  • Povidone-iodine 2.5% or Tetracycline 1% ointment
  • Single dose of Ceftriaxone 50mg/kg I or IV should be given to infants born to mothers with untreated gonococcal infection.