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, towels and wash towels and avoid direct contact with infected materials or individuals
  • Contacts  lenses  should  not  be  worn  in  patients  with  conjunctivitis  until  the  condition  has resolved

Allergic Conjunctivitis

Clinical presentation 

  • Patients present with history of itching of eyes, sand sensation, and sometimes mucoid discharge
  • When examined,
    • the eyes may be normal or slightly red,
    • Conjunctival swelling in severe cases,
    • Limbal hyperpigmentation and papillae of the upper tarsal conjunctiva.
    • Normal iris, pupil and visual acuity.
    • Corneal complications in very advanced stages

Investigations

  • Visual acuity
  • Slit lamp bimicroscopy
  • Full blood picture
  • Skin Allergic test

Non-pharmacological Treatment  

Treatment of allergic conjunctivitis depends on the severity of the condition and age of the patient. In  mild cases where the eyes are white, 

  • Avoid allergens
  • Cold water compresses for 10 minutes four times a day

Pharmacological Treatment 

Adults and children > 6 years of age: 

C: oxymetazoline 0.025% drops 6hourly a maximum of 7days 

If no response within 7days, use mast cell stabilizers such as: 

C: sodium cromoglycate 2% eye drops, instill 6hourly per day (Doctor initiated)  Use may be seasonal (1–3 months) or long term. 

Children 2–6 years of age: 

A: chlorpheniramine (PO) 0.1 mg/kg/dose 6–8hourly 

If no response within 7days use 

C: sodium cromoglycate 2% eye drops, instill 6hourly per day (doctor initiated) 

Use  may  be  seasonal  (1–3  months)  or  long  term  for  the  prevention  of  further attack, depending on the patient’s exposure to the allergen.

Persistent allergic Conjunctivitis in adults and children of >2 years of age: 

For long term use: 

Children 2–6years 

A: cetirizine (PO) Adult; 10mg. Children below 6year 5mg 24hourly 

Use may be seasonal (1–3 months) or long term

Note: Do not give antihistamine to children under 2 years of age as its effectiveness at this age group has  not been proven. 

Referral: Refer to eye specialist for further specialized care in case of the following: 

  • Moderate to severe allergic conjunctivitis
  • No response
  • Persons wearing contact lenses
  • Children <2 years of age

At  the  specialized  centre,  the  following  treatment  may  be  added  depending  on  the  patient’s  presentation: 

Short term steroid eye drops (in severe cases with involvement of the cornea, apart from mast cell  stabilizers, give  

D: dexamethasone 0.1%, 6hourly for a maximum of 14days. 

OR  

D: prednisolone 0.5%, 6hourly for a maximum of 14days. 

In very severe form of allergic conjunctivitis, give steroid injection 

D: triamcinolone acetonide (subtenon) 20mg stat 

OR  

D: methylprednisolone sodium acetate (subtenon) 20mg stat 

Viral Conjunctivitis

The commonest causative organism is adenovirus. It may be unilateral but usually bilateral 

Clinical presentation

  • It may be associated with upper respiratory tract infection
  • Presents with morning crusting and watery eye discharge
  • A burning, sandy or gritty feeling in the eyes
  • Diffuse pink or red conjunctiva due to subconjunctival hemorrhages
  • Photophobia if the cornea is involved
  • Normal visual acuity
  • Preauricular lymphadenopathy
  • It appears in epidemics so there will be history of contact with patients with similar eye condition
  • It is usually is self-limiting, but the irritation and discharge get worse on 3 – 5 days before getting better and symptoms can persist for 2–3 weeks.

Non-pharmacological Treatment 

  • Advise on correct cleansing or rinsing of eyes with clean water
  • Cold compresses for symptomatic relief

Pharmacological Treatment 

Children > 6 years and adults 

C: oxymetazoline 0.025% eye drops, instill 1–2drops 6hourly for a maximum of 7days. 

AND 

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

Note:  Viral  conjunctivitis  is  very  contagious  so  patients  and  members  of  the  family  should  be  alerted 

Referral: Refer all patients to a centre with eye specialist if there is 

  • No response after 5 days
  • Unilateral red eye for more than one day
  • Suspected herpes conjunctivitis
  • Loss of vision
  • Irregular pupil
  • Haziness of cornea
  • Persistent painful eye