Definition of Conjunctivitis

Inflammation of the bulbar and/or palpebral (tarsal) conjunctiva of less than 4 weeks duration

[conjunctiva - thin, filmy membrane that lines the surface of eyelids and covers sclera]

Incidence of Conjunctivitis

Most common eye disorder

Accounts for 1-2% of all ambulatory office visits

Most likely diagnosis in a patient with red eye and discharge

Usually seen in kids

Etiology Information of Conjunctivitis

Infectious

Bacterial - 5%

Viral - 95%

Non-infectious

Allergic

Nonallergic

Etiology of Conjunctivitis

Organisms isolated most commonly:

Acute bacterial (staphylococcal aureus in adults, streptococcus pneumoniae, haemophilus influenzae, pseudomonas aeruginosa, and moraxella catarrhalis in children)

Hyperacute - Nesseria gonorrhoeae (within 24 hours is a medical emergency, and will usually occur in genitals too)

Inclusion & Trachoma - Chlamydial (will usually occur in genitals too)

Neonatal - Chlamydia, N. gonorrhoeae

Differential Diagnosis of Conjunctivitis

Uveitis - iris, ciliary body, choroid

Acute glaucoma

Ocular trauma

Keratitis - corneal infection

Corneal ulcers/foreign body

Dacryocystitis

Pathophysiology of Conjunctivitis

Invading bacteria induce antigen-antibody immune reaction and subsequent inflammation

Defenses includ bacteriostatic lysozymes and immunoglobulins in tear film, the shearing force of the blink, and colonized non-pathogenic bacteria

Two results:

Self-eradication

Infection

Risk Factors of Conjunctivitis

History of contact with infected persons

Direct contact with patient and their secretions

Contact with contaminated surfaces (fomites)

Close contact - daycare, schools

Use of contact lenses

Presentation of Conjunctivitis

Injection

Mucopurulent discharge

Matted eyelids and eyelashes

Mild discomfort

Vision normal

Usually unilateral but may be bilateral

Diagnosis of Conjunctivitis

Usually made clinically so you need a good history and physical

Must document visual acuity

Cornea should be CLEAR

Evert lid to inspect for foreign body

If pupil is irregular - emergent referral

Inspect skin

Discharge

Conjunctiva

Lymph nodes

Ask sexual history

Ask about any problems with housemates

Prognosis of Conjunctivitis

Usually resolves in 10-14 days if untreated

Usually resolves in 2-3 days with treatment

Treatment for Conjunctivitis

Erythromycin ophthalmic ointment

Sulfa ophthalmic drops

Bacitracin ophthalmic ointment

Sulfacetamide ointment

Fluoroquinolone drops - more expensive and rarely justified

Prevention of Conjunctivitis

or Spreading

Wash hands frequently

Avoid rubbing eyes

Don't share washclothes, towels, pillowcases

Don't share eye drops or cosmetics

Etiology of Hyperacute Conjunctivitis

Neisseria species; particularly N. gonorrhoeae

Seen in adults and neonates

Presentation of Hyperacute Conjunctivitis

Copious purulent discharge within 12 hours of inoculation

Rapidly progressive

Includes redness, irritation, tenderness, lid swelling, and tender preauricular adenopathy

Treatment for Hyperacute Conjunctivitis

Ophthalmologic emergency

Diagnosis confirmed by culture

Copius irrigation with salie solution to dilute exotoxins

Single 1 gram dose of ceftriaxone IM is usually adequate (Topical abx may be added)

Patient needs to be seen daily