Treatment of eye infections

Corneal foreign body

Treatment
• Apply a drop of 2% Lignocaine onto the affected eye
• Wipe away the foreign body with a wisp of sterile cotton wool on an orange stick
• If the foreign body does not come out easily refer to the nearest eye clinic where it may need surgical removal
(with a hypodermic needle)
• Chloramphenicol 0.5% eye drops 1 drop every 2 hours, then reduce the frequency as the infection is controlled.
• Pad the eye for 24 hours

Chemical Conjunctivitis

Emergency management
– Apply local anaesthetic – lignocaine 2% eye drops
– Wash the eye copiously with normal saline or tap water for about 30 minutes
Investigation
Fluorescein staining will reveal the area of conjunctival corneal chemical erosion
Treatment
• Hydrocortisone 1% Eye Ointment. Apply 3-4 times daily
• Atropine eye drops 1% 2 times a day

• Tetracycline 1% eye ointment three times daily if infected
Note that the first-line drug of choice is Hydrocortisone. Use Tetracycline as the second line, only if a steroid is not available.

Corneal Ulcers

Treatment
Depends on the cause
For all types of ulcers, prevent ocular pain with atropine
1% once daily in the affected eye
Infections
• Bacteria corneal ulcers: use Tetracycline 1% eye ointment, or Chloramphenicol 1% eye ointment 3-4 times a day
• If not resolving within 2 weeks, then refer

Fungal Ulcers

Typically see main ulcer, with riders, and satellite ulcers around the main one.
(This is seen occasionally. It may not be seen at all)
Treatment
• Povidone Iodine, 2%, four times daily in the affected eye
• Natamycin, 5% eye suspension given hourly for 7 days
• Econazole, 1% suspension for topical use
• Miconazole, 10mg/ml given subconjunctival or intravitreal given as 10microgram per ml
• Amphotericin B 0.05-0.2% can be made from IV injection and instil every
5 minutes during the first hour and 30 - 60minutes until clinical picture changes. (protect from light- use umber coloured bottle)

Viral ulcers, Herpes simplex

Typical characteristic - on Fluorescein 1% or 2% staining a dendritic corneal ulcer (branching)
Treatment
• Acyclovir eye ointment (suspension) five times daily in the affected eye for about 21 days.

Note: If this has a very high association with HIV/AIDS steroids are contraindicated

Ophthalmia neonatorum

Presents 2 – 4 days postpartum
Clinical reactive
Hyperacute conjunctivitis with pus, with or without a membrane‚
Severe swelling of both eyes
Treatment
• Penicillin G 50,0000 IU in 2 divided doses for 7 days – systemic
• Penicillin eye drops 1 hourly both eyes – Topical.

Bacterial Conjunctivitis

Treatment
Tetracycline 1% eye ointment 3 – 6 times daily

Supportive
Good personal hygiene to prevent re-infection
Facial washing.

Viral Epidemic haemorrhagic conjunctivitis

This is a viral infection of the conjunctiva and is associated with bleeding.
The condition is very infectious and difficult to treat. It is often seen in families and epidemics.

Clinical Features
Symptoms
• Pain
• Watery discharge
• Ocular discomfort
• Photophobia

Signs
• Sub conjunctiva haemorrhage (severe redness).
• Tender cervical lymph nodes, preauricular, submental groups
• Swollen conjunctiva
• Water discharge
• Normal vision

Complication
• Secondary bacterial infection

Treatment
• Tetracycline 1% eye ointment 3 times daily for 7 days

Supportive
Patient hygiene – do not share face cloth Wash face and eyes

Zambia