Infective Conjunctivitis

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Introduction

  • The commonest cause of a red eye is infective conjunctivitis

Clinical features

  • Red eye (generalized)
  • Eye discharge: purulent or catarrhal, worse on waking from sleep
  • Eye discomfort: grittiness
  • Photophobia: mild
  • Swollen eyelids in ophthalmia neonatorum

Aetiology

  • Staphylococcus aureus,
  • Pneumococcus
  • Haemophillus influenza,
  • Gonococcus:  
    • Ophthalmia neonatorum
    • Older children or adults after use of infected urine to treat a red eye
  • TRIC agent (chlamydia)
  • Adenovirus: Epidemic keratoconjunctivitis ('Apollo')

Differential diagnoses

  • Allergic conjunctivitis
  • Acute keratitis
  • Acute iritis/uveitis
  • Acute glaucoma

Complications

  • Corneal affectation, which could lead to perforation
  • Endophthalmitis

Investigations

  • Conjunctival swab for microscopy, culture and sensitivity

Non-drug measures

  • Dark glasses for photophobia

Drug treatmentAntibiotic eyedrops or ointments

  • Chloramphenicol 0.5%: Apply one drop at least every 2 hours until infection is controlled then reduce frequency and continue for 48 hours after healing
  • Inclusion conjunctivitis:
    • Sulphonamide drops or tetracycline drops or ointment
    Epidemic keratoconjunctivitis:
    • Antibiotic drops to prevent secondary bacterial infection (chloramphenicol 5% drops)
    • Adult and child over 2 years: apply every 4 hours for no more than 5 days Or:
    • Ofloxacin 0.3% solution applied as stated above Plus:
    • systemic cephalosporin g. ceftriaxone
      • Adult: 1 g every 12 hours intravenously for 7 days
      • Child:
        • 12 years and above: by intravenous infusion over 60 minutes
        • Neonates: 20 - 50 mg/kg once daily, by deep intramuscular injection, intravenous injection over 2 – 4 minutes, or by intravenous infusion
        • 1 month - 12 years (body weight under 50 kg) 50 mg/kg once daily, up to 80 mg/kg in severe infections
    Chlamydia
    • Systemic erythromycin
      • Adults and children over 8 years: 250 - 500 mg orally every 6 hours (or 500 mg - 1 g every 12 hours)
      • 1 month - 2 years: 125 mg orally every 6 hours; dose doubled in severe infections
      • 2 - 8 years: 250 mg 6 hourly
      • 8 - 18 years: 250 - 500 mg 6 hourly; dose doubled in severe infections

Notable adverse drug reactions, contraindications, and caution

  • Steroid drops are absolutely contraindicated

Prevention

  • Wash hands thoroughly after any unhygienic procedure
  • Avoid sharing towels used for cleaning face