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Infective conjunctivitis

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VOL: 100, ISSUE: 32, PAGE NO: 31

WHAT IS IT?

 

WHAT IS IT?
- Conjunctivitis is an acute inflammation of the conjunctiva.

 

 

- The most common causes are due to bacterial or viral infection.

 

 

- Infection can be unilateral or bilateral. However, it normally spreads from one eye to the other.

 

 

- Conjunctivitis is contagious and spreads easily.

 

 

- Contact lenses should not be worn when an infection is present.

 

 

INCIDENCE
- Infective conjunctivitis accounts for around 35 per cent of all eye problems presenting in general practice.

 

 

- In adults, viral conjunctivitis is more common than the bacterial form.

 

 

- Bacterial infection is more common in children.

 

 

RISK FACTORS
- There is an increased incidence in children and older people.

 

 

- Contact lens wearers have an increased risk of infection.

 

 

- Contact with someone who has conjunctivitis is a significant risk factor.

 

 

SYMPTOMS
- The eye appears red with uniform engorgement of all the conjunctival blood vessels.

 

 

- There is burning or gritty discomfort.

 

 

- Vision is usually normal but some patients may describe slight blurring.

 

 

- Photophobia may be mild or absent.

 

 

- On waking, eyes may be stuck together by discharge.

 

 

TREATMENT
- Chloramphenicol is recommended as a first-choice treatment.

 

 

- Fusidic acid is an alternative treatment.

 

 

- Advice should be given regarding not sharing towels with others, taking time off school or work if necessary and avoiding all contact between hands and eyes.

 

 

COMPLICATIONS
- Chronic bacterial conjunctivitis.

 

 

- Corneal ulceration.

 

 

- Otitis media.

 

 

DIFFERENTIAL DIAGNOSIS
- Allergic conjunctivitis has moderate to severe itching. It is important to exclude the presence of a foreign body in the eye.

 

 

- Acute glaucoma has symptoms of ocular and facial pain, unilateral blurring of vision and occasionally nausea and vomiting.

 

 

- Uveitis is associated with pain, photophobia and excessive tearing.

 

 

- Keratitis often presents with a unilateral, acutely painful, photophobic eye.

 

 

- In wearers of soft contact lenses with poor hygiene, prolonged wear or swimming while wearing lenses can cause acanthamoeba keratitis.

 

 

- Severe ocular pain, which may also involve the adjacent head and facial regions, is associated with scleritis.

 

 

- Episcleritis presents as a relatively asymptomatic, acute onset, localised redness in one or both eyes.

 

 

- Orbital cellulitis should be suspected if the person feels unwell with tender sinuses, restriction of eye movements and marked pain symptoms.

 

 

- Ocular herpes simplex typically presents as a painful, red eye with dendritic ulcer seen on staining with fluorescein.

 

 

- Herpes zoster ophthalmicus can cause conjunctival/corneal inflammation with associated vesicular rash in the distribution of the fifth cranial nerve that is seldom recurrent.

 

 

- Blepharoconjunctivitis and meibomianitis should be considered in people with acne rosacea.

 

 

- Dry eye syndrome should be excluded.

 

 

- Hyperacute conjunctivitis is a severe sight-threatening ocular infection, characterised by a copious yellow-green purulent discharge.

 

 

- Nasolacrimal blockage leads to a sump of readily infected stagnant tears. To exclude this, check for regurgitation of pus from the lacrimal puncta by pressing on the lacrimal sac.

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