Conjuctivitis

Bacterial Conjunctivitis

Common causes

1. Staph aureus
2. Staph epidermidis
3. Strep pneumoniae
4. Haemophilus influenzae

spread

Direct contact with infected secretions

Symptoms

1. Subacute onset
2. Redness
3. Grittiness
4. Burning
5. Mucopurulent discharge
6. Often bilateral
7. No photophobia

Signs

1. Crusty lids
2. Conjunctival hyperaemia
3. Mild papillary reaction
4. Lids and conjunctiva may be oedematous.  

Treatment:

• Topical antibiotics effective in 2 to 7 days (except in very severe infections)
• Chloramphenicol or fusidic acid appropriate first-line treatment

Papillae vs follicles

Papillae

Vascular reaction consisting of fibrovascular mounds with central vascular tuft. Can be large- cobblestone or giant papillae-in allergic conjunctivitis

Follicles

Small translucent, avascular mounds of plasma cells and lymphocytes seen in keratoconjunctivits, herpes simplex virus, chlamydia, drug reactions

Chlamydial  Conjunctivitis

Chlamydia trachomatis serotypes D to K occur in sexually active adolescents/ adults (+/- genital infection)

chronic with a mild keratitis.

Symptoms/Signs:

1. Usually unilateral
2. Foreign body sensation
3. Lid crusting with sticky discharge
4. follicles
5. No response with topical antibiotics

diagnosis

1. Swab/ smear
2. Direct monoclonal fluorescent antibody microscopy
3. PCR

Treatment-

1.  topical tetracycline/ oral doxycycline/ azithromycin
2. Contact trace
3. STD clinic referral

Gonococcal conjunctivitis

causative agent - Neisseria gonorhoea
clinical features

1. Acute onset of profuse purulent discharge
2.  conjunctival hyperaemia 
3.  lymphadenopathy
4. Keratitis in severe cases risk of corneal perforation

diagnosis

Ix- gram stain, cultures on chocolate agar
tretment

 cefotaxime, topical gentamicin

STD referal and contact trace

Viral Conjunctivitis

Aetiology

1. Most commonly adenoviral
2.  Adenovirus types 3, 4 and 7
3.  pharyngoconjunctival fever (PCF)
4. Adenovirus types 8 and 9 - epidemic keratoconjunctivitis

Symptoms

1. Acute onset
2. Bilateral
3. Watery discharge
4. Soreness, FB sensation
5. Often no photophobia
6. History of URTI

Treatment:

1. No specific therapy, self resolving, up to two weeks
2. Advice: it is very contagious therefore use care that it will not spread.
3. Topical steroids for keratitis if risk of scarring

Allergic conjuctivitis

Symptoms/Signs:

1. Itch++
2. Bilateral
3. Watery discharge
4. Chemosis (oedema)
5. Papillae (can be giant `cobblestone’ in chronic cases.

Investigation

Exclude infection (generally viral is NOT itchy)

IgE levels Patch testing

Treatment

(severity dependent)

1. cold compresses
2. remove (reduce) allergen
3. NSAIDS
4. antihistamines oral/ topical (olapatanol)
5. mast cell stabilizers (sodium cromoglycate)
6. topical corticosteroids
7. Immunosuppressants (cyclosporin) for steroid resistant cases

1. IMAGES OF CONJUCTIVITIS