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.
- 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.
- 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.
- 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.
- 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.
- Chronic bacterial conjunctivitis.
- Corneal ulceration.
- Otitis media.
- 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.