Bacterial Conjunctivitis

Background

  • Bacterial conjunctivitis is an infection of the eye’s mucous membrane, the conjunctiva, which extends from the back surface of the eyelids (palpebral and tarsal conjunctiva), into the fornices, and onto the globe (bulbar conjunctiva) until it fuses with the cornea at the limbus.

Aetiology

  • Acute bacterial conjunctivitis is most commonly due to Staph aureus, Strep pneumoniae and H Influenzae
    • More rarely caused by others e.g. pseudomonas aeruginosa; moraxella lacunata; Strep viridans and Proteus mirabilis
    • Hyperacute conjunctivitis is mainly due to Niesseria gonorrhoeae.  This cause is also more likely to occur in neonates whose parents are infected with the STI.  Chlamydia is also another cause of bacterial conjunctivitis.  These bacteria should be considered in patients with chronic disease.  It is important to ask about STI exposure at this point too.
  • Risk factors include poor hygiene, contact lens use, other/previous ocular disease e.g. dry eye, blepharitis etc, recent surgery to the eye, foreign body in the eye, immune comprimise

Presentation

  • History
    • Painful (stingy) eye, irritated
    • Yellow/white (non-clear) discharge
    • Often begins in one eye and spreads to other
    • Sticky eyes (particularly in the morning) + crusting
    • Redness
    • Blurry vision (usually due to purulent discharge on the cornea- so usually transient and incomplete- i.e. vision should actually be normal)
    • Light sensitivity
  • Examination
    • Mucopurulent discharge
    • Uniform engorgement of conjunctival vessels
    • Eyelid may be erythematous and occasionally oedematous
    • Normal cornea, anterior chamber, pupils etc

Investigations

  • Usually not necessary
  • If disease is chronic and not responding to treatment, discharge cultures may be helpful (conjunctival scrapings can also be done for stain/cultures)

Management

  • In most people, infective conjunctivitis is self-limiting and antibiotic treatment has little impact on the time to recovery and carries side-effects
    • Therefore, advice on self-care is all that is required for most patients
      • no contact lenses
      • clean away secretions
      • hand-washing
    • lubrication drops may help to reduce discomfort if this is a problem for the patient
  • Consider giving an antibiotic (topical chloramphenicol 1st line- fusidic acid 2nd line) in severe disease (or likely to become severe)
    • NB definition of severe is subjective based on patient distress and clinical experience
    • If the patient requests antibiotics, suggests delay for 1 week to see if it resolves spontaneously
  • In cases of gonococcal/chlamydial infection, systemic treatment is usually required (azithromycin 1g once only (+ 500mg ceftriaxone IM for gonorrhoea))

see http://cks.nice.org.uk/conjunctivitis-infective#!topicsummary

 

 

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