Acute conjunctivitis

Opthalmology

Clinicals - History

Fact Explanation
Sticky eye lids Sticky eye lids is commonly encountered with bacterial conjunctivitis. Patients often complain of inability to open their eyes in waking up in the mornings. Sticky eye lids
Sticky eye lids is commonly encountered with bacterial conjunctivitis. Patients often complain of inability to open their eyes in waking up in the mornings.
Red eye Conjunctivitis causes inflammation of the conjunctiva resulting in red eyes. Red eye
Conjunctivitis causes inflammation of the conjunctiva resulting in red eyes.
Discharge Purulent discharge is common presentation of bacterial conjunctivitis. Neonatal conjunctivitis presents with unilateral or bilateral purulent discharge once the neonate is about a week old. Gonococcal conjunctivitis presents with profuse discharge and it presents in the first week of life. Viral and allergic conjunctivitis presents with watery discharge. Discharge
Purulent discharge is common presentation of bacterial conjunctivitis. Neonatal conjunctivitis presents with unilateral or bilateral purulent discharge once the neonate is about a week old. Gonococcal conjunctivitis presents with profuse discharge and it presents in the first week of life. Viral and allergic conjunctivitis presents with watery discharge.
Pain Pain in the eye can be a presenting complain of some patients especially in gonococcal conjunctivitis but severe eye pain should be considered a red flag and immediate referral to an ophthalmologist is indicated. This is due to the risk of developing corneal opacities, corneal perforations and endophthalmitis with gonococcal conjunctivitis. Bacterial conjunctivitis usually presents with no pain. Pain
Pain in the eye can be a presenting complain of some patients especially in gonococcal conjunctivitis but severe eye pain should be considered a red flag and immediate referral to an ophthalmologist is indicated. This is due to the risk of developing corneal opacities, corneal perforations and endophthalmitis with gonococcal conjunctivitis. Bacterial conjunctivitis usually presents with no pain.
Itching Itchy eyes is another complain of conjunctivitis, commonly seen in allergic and viral conjunctivitis. Itching
Itchy eyes is another complain of conjunctivitis, commonly seen in allergic and viral conjunctivitis.
Symptoms of upper respiratory tract infection Patients with viral conjunctivitis present with symptoms of upper respiratory tract infection like cough and runny nose. Symptoms of upper respiratory tract infection
Patients with viral conjunctivitis present with symptoms of upper respiratory tract infection like cough and runny nose.
Symptoms of otitis media Commonly Haemophilus influenzae and less commonly Streptococcus pneumoniae can cause conjunctivitis-otitis syndrome which is commonly seen in children. Earache and discharge are common symptoms. Symptoms of otitis media
Commonly Haemophilus influenzae and less commonly Streptococcus pneumoniae can cause conjunctivitis-otitis syndrome which is commonly seen in children. Earache and discharge are common symptoms.
Reduced vision Reduced vision is a symptom that should be concerned serious. Bacterial conjunctivitis usually do not cause impaired vision unless the discharged pus obscure the vision. Reduced vision
Reduced vision is a symptom that should be concerned serious. Bacterial conjunctivitis usually do not cause impaired vision unless the discharged pus obscure the vision.
Contact history Conjunctivitis can spread from person to person. Some infants with neonatal conjunctivitis due to Chlamydia infection can develop chlamydial pneumonitis which then result in recurrent conjunctivitis in about 50% of the affected neonates. Contact history
Conjunctivitis can spread from person to person. Some infants with neonatal conjunctivitis due to Chlamydia infection can develop chlamydial pneumonitis which then result in recurrent conjunctivitis in about 50% of the affected neonates.
Risk factors Conjunctivitis is commoner among contact lens users. Chronic dry eye and lagophthalmos (inability to close the eyes completely) are predisposing factors for recurrent conjunctivitis. Immunodeficiency syndromes and systemic immunosuppression are other predisposing factors for bacterial conjunctivitis. Risk factors
Conjunctivitis is commoner among contact lens users. Chronic dry eye and lagophthalmos (inability to close the eyes completely) are predisposing factors for recurrent conjunctivitis. Immunodeficiency syndromes and systemic immunosuppression are other predisposing factors for bacterial conjunctivitis.
History of gonococcal or chlamydial infection Genital infections can be asymptomatic in some patients.
Neonatal conjunctivitis is a common sequale of untreated cervical chlamydial infection in pregnant mothers.
History of gonococcal or chlamydial infection
Genital infections can be asymptomatic in some patients.
Neonatal conjunctivitis is a common sequale of untreated cervical chlamydial infection in pregnant mothers.

Clinicals - Examination

Fact Explanation
Discharge Purulent discharge can be seen in bacterial conjunctivitis commonly with gonococcal conjunctivitis. In gonococcal conjunctivitis it is often thick and yellow green in color. Discharge
Purulent discharge can be seen in bacterial conjunctivitis commonly with gonococcal conjunctivitis. In gonococcal conjunctivitis it is often thick and yellow green in color.
Erythema Erythema of the conjunctiva can be seen due to inflammation. It is common inside of the eyelids and over the periphery of the bulbar conjunctiva. Erythema
Erythema of the conjunctiva can be seen due to inflammation. It is common inside of the eyelids and over the periphery of the bulbar conjunctiva.
Chemosis Conjunctival edema can be detected due to the presence of inflammation. This occurs with dilatation and increased permeability of the vessels in the conjunctiva. Chemosis
Conjunctival edema can be detected due to the presence of inflammation. This occurs with dilatation and increased permeability of the vessels in the conjunctiva.
Visual acuity Visual acuity should be checked in every patient. It can be reduced due to excessive purulent discharge. Visual acuity
Visual acuity should be checked in every patient. It can be reduced due to excessive purulent discharge.
Lymphadenopathy Presence of ipsilateral preauricular lymphadenopathy strongly suggest a viral etiology. Lymphadenopathy
Presence of ipsilateral preauricular lymphadenopathy strongly suggest a viral etiology.

Investigations - Diagnosis

Fact Explanation
Culture Although culture is not a must infectious organism can be isolated form the cultures.
Neisseria gonorrhoeae and Chlamydia trachomatis are common organisms causing neonatal conjunctivitis. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae less commonly isolated organisms which can cause neonatal conjunctivitis. The first two organisms however common to cause conjunctivitis in children and less commonly Moraxella species, S aureus, and coagulase-negative staphylococci can also be the etiological factor for bacterial conjunctivitis in children.
H influenzae and S aureus cause conjunctivitis in adults. S pneumoniae, coagulase-negative staphylococci, and Moraxella and Acinetobacter species are less commonly isolated from adults,
Culture
Although culture is not a must infectious organism can be isolated form the cultures.
Neisseria gonorrhoeae and Chlamydia trachomatis are common organisms causing neonatal conjunctivitis. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae less commonly isolated organisms which can cause neonatal conjunctivitis. The first two organisms however common to cause conjunctivitis in children and less commonly Moraxella species, S aureus, and coagulase-negative staphylococci can also be the etiological factor for bacterial conjunctivitis in children.
H influenzae and S aureus cause conjunctivitis in adults. S pneumoniae, coagulase-negative staphylococci, and Moraxella and Acinetobacter species are less commonly isolated from adults,

Management - Supportive

Fact Explanation
Health education Patients with conjunctivitis should keep their eyes clean with minimal touching. Infected persons should use a handkerchief and should wash their hands before touching the eyes.
Patients who had gonococcal or chlamydial conjunctivitis should be educated about the barrier methods of contraception and their sexual partners should be traced and treated as well.
Patients should refrain form using contact lenses until the infection settles. Disposable lenses should replaced with new ones. They should adhere to proper cleaning of the lenses as recommended.
Patients should seek the help of an ophthalmologist if there is no improvement after 24 hours of antibiotic treatment.
Health education
Patients with conjunctivitis should keep their eyes clean with minimal touching. Infected persons should use a handkerchief and should wash their hands before touching the eyes.
Patients who had gonococcal or chlamydial conjunctivitis should be educated about the barrier methods of contraception and their sexual partners should be traced and treated as well.
Patients should refrain form using contact lenses until the infection settles. Disposable lenses should replaced with new ones. They should adhere to proper cleaning of the lenses as recommended.
Patients should seek the help of an ophthalmologist if there is no improvement after 24 hours of antibiotic treatment.
Lubricating eye drops Although not always necessary these may be helpful to fasten the recovery. Lubricating eye drops
Although not always necessary these may be helpful to fasten the recovery.
Washing Infected eyes should be washed with sterile saline water. Washing
Infected eyes should be washed with sterile saline water.

Management - Specific

Fact Explanation
Conservative management Most of the patients with bacterial conjunctivitis recover uneventfully. Conservative management
Most of the patients with bacterial conjunctivitis recover uneventfully.
Antibiotics Most of the infective organisms causing conjunctivitis can be treated with topical antibiotics however gonococcal and chlamydial conjunctivitis need systemic antibiotics for the treatment. Single dose of intramuscular ceftriaxone is indicated for the treatment of gonococcal conjunctivitis. Neonatal chalamydial conjunctivitis is treated with oral erythromycin for 14 days.
Single dose of azithromycin (1 g) is recommended for the treatment of chlamydial conjunctivitis in adults.
Antibiotics
Most of the infective organisms causing conjunctivitis can be treated with topical antibiotics however gonococcal and chlamydial conjunctivitis need systemic antibiotics for the treatment. Single dose of intramuscular ceftriaxone is indicated for the treatment of gonococcal conjunctivitis. Neonatal chalamydial conjunctivitis is treated with oral erythromycin for 14 days.
Single dose of azithromycin (1 g) is recommended for the treatment of chlamydial conjunctivitis in adults.

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