Bacterial Conjunctivitis

Question 1

Aetiology

Answer 1

infection of conjunctiva caused by:
Streptococcus (+)
Staphylococcus (+)
Haemophilus Influenza (-)
Moraxella Cattarhalis (-)

Gonococcal conjunctivitis is caused by Neiserria gonorrhoeae - presents with eye pain, chemosis and significant purulent discharge - can be sight threatening if untreated leading to corneal ulceration / perforation.

Question 2

Predisposing factors

Answer 2

Children and elderly more at risk
Significant conjunctivitis in first month of life should be treated as emergency - ophthalmic neonaturum.

Blepharitis
CL wear
Superficial trauma
Diabetes
Immunocompromised
Secondary to viral conjunctivitis
Contamination of ocular surface

Question 3

Symptoms

Answer 3

Sudden onset of redness, discomfort (burning, grittiness), discharge (blurs vision), crusting (eyelids stuck together on waking, needs to be bathed open)

typically bilateral but can start with one eye before spreading to the other

if significant pain, redness, and discharge, suspect gonococcal conjunctivitis

Question 4

Signs

Answer 4

Lid crusting and swelling
Conjunctival hyperaemia
Mucopurulent or purulent discharge
Chemosis
Tarsal conj may show mild papillary reaction
Cornea - uninvolved but may have mild inferior SPK, if significant corneal involvement, suspect gonococcal.

Question 5

Non-pharmacological Management

Answer 5

Self limiting condition in 5-7 days
Bathe eyelid and keep eye area clean with sterile saline and cooled boiled water to remove crusts.
Advise of contagious nature - avoid sharing towels, touching eye.
No time off work needed.

Question 6

Pharmacological management

Answer 6

Topical antibiotic can be issued if the benefits outweigh the risks of antibiotic resistance - to render Px less infectious to others e.g. if working in HC setting.

CPL 0.5% eye drops
CPL 1% eye ointment
Azithromycin 1.5% eye drops
Fusidic Acid 1% eye drops - narrow spectrum and more expensive.

For CL wear, consider fluoroquinolone such as Levofloxacin / Moxifloxacine or a aeminoglycaside such as Gentamicin - these perform better against bacteria found in CL wearers.

Question 7

Referral?

Answer 7

usually no referral, manage to resolution
if failure to resolve, and corneal involvement, refer within 1 week to ophthalmology (URGENT)
if suspecting gonococcal, same day emergency.