Conjunctivitis

Definition

Infection of conjunctiva

Epidemiology

Commoner than the common housefly. Which is common.

Pathophysiology

There are three things that commonly cause a conjunctivitis: bacteria, viruses or allergy.

Clinical Features

General features:

• Red eye
• Itch and irritation - maybe described as painful but severe pain suggests something more severe.
• Discharge

Acuity, cornea, pupil and intraocular pressure should all be normal

Bacterial

Bacterial conjunctivitis is the most common and the following are generally present in that condition:

• Previous history of bacterial conjunctivitis
• Itch
• Mucopurulent discharge (glue eye) - sometimes in viral and allergic conjunctivitis you also get sticky eyes but the discharge with bacteria is sticky, purulent but scant. If it's really badly purulent, there's a change it is gonococcal or chlamydial in which case it needs to be seen by a specialist and swabbed

Viral

Viral conjunctivitis tends to present with a watery discharge, eyelid oedema, follicles (lymphoid collections on the conjunctiva), pre-auricular lymphadeopathy. The key with viral is to check if it's herpetic: unilateral, burning, foreign body sensation.

Allergic

Itch and burning with concurrent contact dermatitis. Lid oedema and papillae (vascular bulges).

Investigation

Swab if severe bacterial infection suspected (gonorrhoea or chlamydia)

Management

Generally - discontinue contact lens wear, be careful with hygeine and don't share towels.

• Basically, if it's bacterial give chloramphenicol (alternative is fusidic acid).
• Viral needs good hygeine and it should go away (antihistamines and steroids may help).
• And if it's allergic, avoid the allergen, avoid contact lenses, use lubricants and don't rub eyes.

Refer

If gonococcal, chlamydial or herpetic infection suspected.