Conjunctivitis

Question 1

What is the most common eye problem presenting to primary care?

Answer 1

Infective conjunctivitis (‘pink eye’)

Question 2

What is conjunctivitis?

Answer 2

Inflammation of the conjunctiva (thin transparent membrane that covers the sclera and lines the inner surface of the eyelines).

Question 3

Common bacterial organisms causing infective conjunctivitis? (4)

Answer 3

1) Staph. aureus

2) Strep. pneumoniae

3) H. influenzae

4) Moraxella catarrhalis

Question 4

Most common viral cause of conjunctivitis?

Answer 4

Adenovirus

Question 5

Give 4 viral causes of conjunctivitis

Answer 5

1) Adenovirus (most common)

2) Herpes simplex virus (HSV)

3) Varicella-zoster virus (VZV)

4) Enterovirus

Question 6

Features of bacterial conjunctivitis?

Answer 6

• purulent discharge
• eyes may be ‘stuck together’ in morning

Question 7

Features of viral conjunctivitis?

Answer 7

• serous discharge
• recent URTI
• preauricular lymph nodes

Question 8

Risk factors for infective conjunctivitis?

Answer 8

• recent exposure to an infected individual
• swimming in contaminated water
• contact lens use

Question 9

Are infective conjunctivitis symptoms unilateral or bilateral?

Answer 9

Acute onset of symptoms, typically unilateral but may become bilateral within 24-48 hours.

Question 10

Symptoms of infective conjunctivitis?

Answer 10

• Ocular discomfort, itching, burning sensation.
• Foreign body sensation or grittiness in the affected eye(s).
• Photophobia (viral)
• Discharge: watery (viral) or purulent (bacterial)

Question 11

Does photophobia indicate bacterial or viral conjunctivitis?

Answer 11

Viral

Question 12

Signs of infective conjunctivitis?

Answer 12

• Conjunctival injection and chemosis.
• Eyelid swelling and erythema.
• Palpable preauricular lymphadenopathy, particularly in viral conjunctivitis.
• Subconjunctival haemorrhage may be present in cases of adenoviral conjunctivitis.

Question 13

Location of possible lymphadenopathy in viral conjunctivitis?

Answer 13

Preauricular lymphadenopathy

Question 14

Mx of infective conjunctivitis?

Answer 14

• normally a self-limiting condition that usually settles without treatment within 1-2 weeks
• topical abx therapy e.g. Chloramphenicol (fusic acid alternative in pregnant women)
• contact lens should not be worn during an episode of conjunctivitis
• advice should be given not to share towels
• school exclusion is not necessary

Question 15

Option for bacterial conjunctivitis in pregnant woman?

Answer 15

Fusidic acid

Question 16

What is allergic conjunctivitis?

Answer 16

Immune response to various environmental allergens, such as pollen, animal dander, and dust mites

Question 17

What type of hypersensitivity reaction is allergic conjunctivitis?

Answer 17

Type I

Question 18

Clinical features of allergic conjunctivitis?

Answer 18

• Bilateral ocular itching and redness
• Watery or stringy, mucoid discharge
• Conjunctival chemosis and hyperemia
• Eyelid oedema and erythema
• Tearing and photophobia

Question 19

Mx of allergic conjunctivitis?

Answer 19

1) Allergen avoidance

2) Basic eye care:
- avoid rubbing eyes as this may cause mast cell degranulation
- cool compresses

3) Topical antihistamines: e.g. olopatadine, ketotifen