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Red Eyes at Halloween Conjunctivitis can be classified as infectious or noninfectious and as acute, chronic, or recurrent. The causes of infectious conjunctivitis include viruses and bacteria. The types of noninfectious conjunctivitis are allergic, mechanical/irritative/toxic, immune‐mediated, and neoplastic. The causes for noninfectious conjunctivitis may overlap. Bacterial Conjunctivitis Mild bacterial conjunctivitis may be self‐limited and resolve spontaneously without specific treatment in immune‐competent adults. Use of topical antibacterial therapy is associated with earlier clinical and microbiological remission compared with placebo in days 2 to 5 of treatment. These advantages persist over days 6 to 10, but the extent of benefit over placebo lessens over time. The choice of antibiotic is usually empirical. Since a 5‐to‐7‐day course of a broad‐spectrum topical antibiotic is usually effective, the most convenient or least expensive option can be selected. A common first choice drop is Polytrim (polymyxin B and Trimethoprim sulfate) as it has broad coverage, comes in a large bottle, and has minimal stinging. A typical dosing regimen is one drop 4 x a day for a week. Viral Conjunctivitis The majority of conjunctivitis is caused by a virus – like having a cold in the eye. A prominent pre‐auricular lymph node is common. The discharge is not purulent. In this self limited condition only symptomatic treatments such as cool compresses and artificial tears are required. It is important to remind patients to wash their hands frequently and to use a separate set of hand towels. “Halloween” Conjunctivitis
In the age of the internet, decorative costume contact lenses are easily available without a prescription. Although advertised as “no fitting required” nothing could be farther from the truth. A poor fitting contact lens can cause an epithelial defect leading to a bacterial keratitis, scarring and vision loss. Keratitis describes the situation beyond conjunctivitis where the cornea itself has become infected. A red flag sign is a white spot in the cornea. © 2010 HealthPartners
Careful examination of the cornea with a penlight and staining with Fluoroscein dye is done to look for epithelial defects and white infiltrates in the corneal stroma. These are signs of cornea involvement and comprise a more serious vision threatening situation. If a cornea ulcer is suspected, begin a quinolone antibiotic and consult with the ophthalmologist on call. The typical first choice is Zymar with usage as frequent as hourly around the clock. Red flag symptoms are pain and loss of vision. A red flag sign is a white spot on the cornea that typically will stain with the fluoroscein dye. In many cases it is appropriate to initiate treatment and follow‐up with ophthalmology. References: 1. American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern® Guidelines. Conjunctivitis. San Francisco, CA: American Academy of Ophthalmology; 2008. Available at: http://www.aao.org/ppp. 2. Eye Contact Lens. 2003 Oct;29(4):196‐200. Ocular complications associated with the use of cosmetic contact lenses from unlicensed vendors. Steinemann TL, Pinninti U, Szczotka LB, Eiferman RA, Price FW Jr. Division of Ophthalmology, MetroHealth Medical Center, Cleveland, OH. [email protected] Questions: Please reply to this e‐mail, and your questions(s) will be directed to the author of this Pearl, Dr. David Johnson. Pearl Archive: www.imehealthpartners.com
All Pearl recommendations are consistent with professional society guidelines, and reviewed by HealthPartners Physician Leadership. © 2010 HealthPartners