Conjunctivitis

Question 1

What is conjunctivitis?

Answer 1

• inflammation of the lining of the eyelids and eyeball
• common, not usually serious
• can be uni or bilateral

Question 2

Describe the signs and symptoms of conjunctivitis

Answer 2

• discharge
  
  • watery -> viral
  • ropy, mucoid -> allergic
  • purulent -> bacterial
• itching
• eyelids stuck together in morning
• tender, pre-auricular lymphadenopathy

Question 3

What are the most common bacterial pathogens in infective conjunctivitis?

Answer 3

• pneumococcus
• staph aureus
• moraxella catarrhalis
• haemophilus influenzae

Rarely, neisseria gonorrhoea cause a hyperacute purulent conjunctivitis; the organism is transmitted from genitalia to hands then to eyes. Chlamydia is a common cause of persistent conjuntivitis

Question 4

What organisms cause viral conjunctivitis?

Answer 4

• adenovirus (~80%)
• herpes simplex
• epstein-barr
• varicella zoster
• molluscum contagiosum
• coxsackie
• enteroviruses

Adenoviral conjunctivitis usually causes epidemic keratoconjunctivitis, follicular conjunctivitis, and non-specific conjunctivitis.

Viral conjunctivitis is highly contagious and spreads by direct contact w/ ppl or contaminated surfaces exposed to secretions.

Question 5

Hyperacute presentation over 24 to 48 hours with copious whitish-yellow discharge in a sexually active person is consistent with what type of conjunctivitis?

Answer 5

• neisseria gonorrhoeae

Question 6

Following an uneventful pregnancy, a 19-year-old woman delivers a male child vaginally. At assessment one week later the child is noted to have purulent discharge and crusting of the eyelids.

What is the next step in the management of the child?

(source: passmed)

Answer 6

• Take urgent swabs of discharge for microbiological investigation

Although minor conjunctivitis with encrusting of the eyelids is common and often benign, a purulent discharge may indicate the presence of a serious infection (for example, with chlamydia or gonococcus).

In babies with a purulent eye discharge swab samples should be taken urgently for microbiological investigation, using methods that can detect chlamydia and gonococcus. While the guidance is to start systemic antibiotic treatment for possible gonococcal infection while awaiting the swab microbiology results, swabs must be taken first.

Question 7

What are the types of conjunctivitis?

Answer 7

Infective

Allergic (hayfever)

Chemical(e.g. alkali)

Auto-immune (e.g. Stevens-Johnson)

Question 8

Management of allergic conjunctivitis

Answer 8

Treat with Opatanol BD during hayfever season

Question 9

Timescales of infective conjunctivitis

Answer 9

Bacterial

Self-resolving in 5-7 days

Viral

Self-resolving in 1-3 weeks

Question 10

Management of infective conjunctvitis

Answer 10

Drops or ointment chloramphenicol QDS 5-7 days

Hand-washing

Do not share towels

HCP off work

Schools may exclude children