Conjunctivitis (including Trachoma)

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Differential Diagnosis: Causes of conjunctivitis

Signs/Symptoms	Acute bacterial	Viral	Allergic	Chronic, endemic trachoma
Discharge?	✓ Purulent	✓ Watery /none	Mucoid	None/ purulent
Itching?	None	None	✓Marked	None
One or both eyes?	One or both	One or both	Both	Usually both
Recurrences?	Unusual	Unusual	Usually	✓Chronic

Note: ✓ Bold lettering indicates distinguishing feature.

Treatment of conjunctivitis:

Acute bacterial conjunctivitis:

Medicine	Adult Dose	Duration	Frequency
tetracycline 1% eye ointment	Apply	3 times a day	one week
chloramphenicol 1% eye ointment	Apply	4 times day	one week

Viral conjunctivitis:

• No medicine treatment as this is a self-resolving infection. If in doubt treat as for acute bacterial and refer.

Allergic conjunctivitis:

• Educate/ reassure. Apply cold compresses and wear a sun hat whenever outdoors. If no relief of symptoms refer. A night-time dose of an antihistamine may relieve symptoms.
• NB: Steroids are contraindicated in allergic conjunctivitis

Medicine	Adult Dose	Frequency	Duration
Olopatidine (patenol) 1% eye drops	apply	twice daily	2 weeks

If no improvement in the three conjunctivitis - refer

Trachoma:

If left untreated, the cornea becomes permanently and irreversibly damaged. Apply:

Medicine	Adult Dose	Frequency	Duration
Tetracycline 1% eye ointment	apply	4 times a day	for 6 weeks

• If inturned eye lashes (trichiasis, entropion) present, perform epilation (pull out the lashes) and refer the patient to the eye hospital.
• Provide education in personal and environmental hygiene for prevention of trachoma, with emphasis on face washing, not sharing towels, hand washing, provision of safe water supplies and basic sanitation.