Conjunctivitis

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This is an inflammation of the conjunctivae and one of the most common causes of red eyes. The cause of conjunctivitis may be bacterial, viral or allergy. Clinical features and treatment guideline depend on the type and cause of conjunctivitis.

Note: 
If conjunctivitis is due to an infection, counsel on the importance of frequent hand washing, use separate linen and towels, wash towels and avoid direct contact with infected materials or individuals.

Contact lenses should not be worn in patient with conjunctivitis until the condition has resolved. 

Bacterial Conjunctivitis

Purulent conjunctival inflammation caused by bacterial infection 

Clinical presentation  It is characterized by: 

  • Mucopurulent  discharge  from  one or both eyes
  • Sore,  gritty  or  scratch  eyes  and swollen lids
  • Conjunctiva redness more at the fornices
  • Eyelids may be swollen
  • Matting of the eye lashes in the morning with eyelids stuck shut

Non-pharmacological Treatment 

  • Educate patient on personal hygiene to prevent spread
  • Educate patient on correct application of ophthalmic ointment
    • To wash hands thoroughly before applying ophthalmic ointment
    • Not to share the ophthalmic ointment and drops
  • Eye swabs for Gram stain and for culture and sensitivity may be needed to tailor down treatment.

Pharmacological Treatment 

A: chloramphenicol 1%, ophthalmic ointment, applied 8hourly for 5days. 

OR 

C:  ciprofloxacin  0.3%,  ophthalmic  drops,  instill  1drop,  4hourly  for  2days.  Then  reduce frequency to 1 drop 6hourly for 5days 

OR 

D:  ofloxacin  0.3%,  ophthalmic  drops,  instill  1  drop  4hourly  for  2days.  Then  reduce  the frequency to 1drop 6hourly for 5days 

AND 

A: paracetamol (PO) Adult 1g. Children 10–15 mg/kg/dose 6hourly when required. 

Referral: Refer to eye specialist if no improvement after 2days of treatment 

Ophthalmia Neonatorum/Neonatal Conjunctivitis

This is acute bacterial infection of the eyes that affect newborn baby during the first 28days of life.  The infection is acquired from mother’s birth canal secretions. It is characterized by inflammation of the  conjunctivae,  sticky  eyes  to  abundant  purulent  discharge  and  eyelids  oedema.  Causative  organisms are Neisseria Gonorrhea, Chlamydia spp and Staphylococcus spp.  

Clinical presentation 

  • Patients  present  with  massive  edema  and  redness  of  eyelids  and  with  purulent  and copious discharge from the eyes, clinical presentation ranges from mild (small amount of sticky  exudates)  to  severe  form  (profuse  pus  and  swollen  eye  lids)  depending  on  the causative organism
  • There  is  usually  rapid  ulceration  and  perforation  of  corneal  which  eventually  leads  to blindness if treatment is delayed
  • It usually presents 3–4days of life
  • Late and mild presentation is due to Staphylococcus or undefined
  • Treat parents of a neonate with purulent discharge appropriately

Investigations 

  • Pus swab for Gram Stain
  • Pus for Culture and sensitivity
  • Vaginal swab for Gram stain and culture and sensitivity

Non-pharmacological Treatment 

Cleanse or wipe eyes of all newborn babies with a clean cloth, cotton wool or swab, taking care not  to touch or injure the eye  

Pharmacological Treatment  

Screen women in the antenatal clinics and treat both parents for Sexually Transmitted Diseases. In  Ophthalmia neonatorum, prevention is better than cure. 

A: Apply chloramphenicol 1% eye ointment, both eyes, to all newborn babies as  soon as possible after birth

OR 

A: povidone iodine 2.5% Eye Drops, both eyes 

Sticky eye(s) without purulent discharge: 

A: chloramphenicol 1% eye ointment, apply 6hourly for 7days 

Purulent discharge 

Mild discharge without swollen eyelids and no corneal haziness: 

A:  compound  sodium  lactate  eye  wash,  immediately  then  2–3hourly  until discharge clears 

AND 

B: ceftriaxone (IM) 50mg/kg immediately stat 

Given at District Hospital (Treatment to be initiated by Clinical Eye Care Professional eg. Assistant Medical Officer in Ophthalmology) 

Abundant purulent discharge and/or swollen eyelids and /or corneal haziness: 

A: compound sodium lactate eye wash, immediately then hourly until referral 

AND 

B: ceftriaxone (IM) 50mg/kg immediately stat 

Referral: To high level health facilities for proper management. 

Note:   

  • Ceftriaxone should not be used in neonates that are seriously ill or are jaundiced
  • Ceftriaxone  should  not  be  administered  if  calcium  containing  intravenous  infusion  e.g Compound Sodium Lactate is given or is expected to be given

Treat both parents of newborns who develop purulent conjunctivitis after 24 hours of birth for N- gonorrhea and Chlamydia with  

B: ceftriaxone (IM) 250mg stat 

(For  ceftriaxone  IM  injection:  Dissolve  Ceftriaxone  250mg  in  0.9  mL  Lidocaine  1% without adrenaline) 

AND 

B: azithromycin (PO) 1g stat 

Note: For  more  details  on  prevention  and  treatment  see  the  “Neonatal  Conjunctivitis  (NC)  Flow Chart Number 12.8" under the Sexual Transmitted disease chapter  

Referral: Urgently 

  • Neonates  with  abundant  purulent  discharge  and/or  swollen  eyelids  and/or  corneal haziness 
  • Neonates unresponsive to treatment within 2days.