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Infective conjunctivitis

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



- 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.

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