Download Acute Conjuctivitis

Acute Conjuctivitis
Lawrence Pike
Definition
 Acute inflammation of the conjunctiva due
to either viral or bacterial infection
Causes
• Viral causes
– include adenovirus, Herpes simplex.
• Bacterial causes
– include Streptococcus pneumoniae, Staphylococcus
aureus, Haemophilus influenzae..
• Ophthalmia neonatorum
– is conjunctivitis secondary to gonorrhoea or
chlamydia within the first month of life.
Incidence
• Conjunctivitis is the most common cause of 'red
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•
•
eye'.
Conjunctivitis accounts for around 44% of all
eye problems presenting in general practice
[Manners 1997].
2-5% of all general practice consultations are
eye related [Manners 1997].
Viral conjunctivitis is more common than
bacterial conjunctivitis [Baum 1995].
Symptoms and Signs
• 'Red eye' (diffuse conjunctival injection).
• Eye discomfort/burning/gritty sensation
(not painful).
• Minimal pruritus.
• Vision is usually normal - although
'smearing', particularly on waking, may be
common.
• Photophobia mild or absent.
Symptoms and Signs (cont.)
• May be unilateral or bilateral, although usually
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•
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starts in one eye (not discriminatory of cause).
Association with URTI, watery discharge, and
preauricular lymphadenopathy are suggestive of
viral cause.
A purulent discharge suggests bacterial cause.
History of contact with similarly affected person
is common.
Differential Diagnosis
• Orbital cellulitis
– Admit urgently if this is suspected (patient is unwell, tender
sinuses, restriction of eye movements).
• Allergic conjunctivitis
– suggested by moderate to severe pruritus.
• Uveitis (Iritis)
– presents with pain, photophobia and excessive tearing.
• Acute glaucoma (angle closure).
– Symptoms of ocular and facial pain, unilateral blurring of vision
and occasionally nausea and vomiting. The pupil is usually middilated, oval and non-reactive to light.
Differential Diagnosis (cont.)
• Keratitis
– presents with a unilateral, acutely painful, photophobic, intensely
injected eye.
• Scleritis
– presents with severe, boring ocular pain, which may also involve
the adjacent head and facial regions.
• Episcleritis
– presents as a relatively asymptomatic acute onset localised
redness in one or both eyes.
• Herpetic (dendritic) ulcer
– painful, stains with fluorescein.
• Herpes zoster
– vesicular eruption suggestive of shingles.
What can go wrong?
• Chronic conjunctivitis.
• Corneal ulceration.
• Wrong diagnosis.
Management Issues
General measures
• Conjunctivitis is contagious (particularly
•
adenoviral). Advice should be given regarding
sharing of towels, utensils etc with others, time
off school/work if necessary, and minimal
hand/eye contact. Doctors should also be aware
of sterile techniques to avoid crosscontamination of instruments etc. [Donahue
1996]
Contact lenses should not be worn if
conjunctivitis is present or if topical treatments
are being instilled.
Treatment of infection
• A topical antibacterial preparation is
usually prescribed empirically for the
following reasons
– In most cases it is clinically difficult to distinguish
between viral and bacterial infection.
– Bacterial superinfection can occur in cases of viral
conjunctivitis.
– To relieve symptoms and shorten the course of
disease (spontaneous remission is likely to occur
within several weeks [Baum 1995; Barza 1983]).
Treatment (cont.)
• Chloramphenicol
– remains the drug of choice for all superficial
eye infections in the U.K. as it is effective,
reliable, broad spectrum and cheap. Previous
concerns over its association with aplastic
anaemia have largely been discounted
• Fusidic Acid
– is an alternative that is more expensive but
only twice daily