Acute Conjuctivitis

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Acute Conjuctivitis

• Lawrence Pike

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Definition

• Acute inflammation of the conjunctiva due to
  either viral or bacterial infection

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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.

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Incidence

• Conjunctivitis is the most common cause of 'red
  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.

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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.

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Symptoms and Signs (cont.)

• May be unilateral or bilateral, although usually
  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.

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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 mid-dilated, oval
  and non-reactive to light.

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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.

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What can go wrong?

• Chronic conjunctivitis.
• Corneal ulceration.
• Wrong diagnosis.

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Management IssuesGeneral 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 cross-contamination
  of instruments etc. Donahue 1996
• Contact lenses should not be worn if
  conjunctivitis is present or if topical
  treatments are being instilled.

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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).

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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