Infective Conjunctivitis (Pinkeye)

Introduction

The commonest cause of a red eye is infective conjunctivitis, which could be caused by bacteria or viruses. Conjunctivitis occurs when the conjunctiva of the eye becomes inflamed.

Clinical features

  • Red eye (generalized)
  • Eye discharge: purulent or catarrhal, worse on waking from sleep
  • Eye discomfort: grittiness
  • Photophobia: mild
  • Swollen eyelids in ophthalmia neonatorum

Aetiology

  • Staphylococcus aureus,
  • Pneumococcus
  • Haemophillus influenza,
  • Ophthalmia neonatorum
  • Gonococcus
  • TRIC agent (chlamydia)
  • Adenovirus: Epidemic
  • keratoconjunctivitis
    (‘Apollo’)

Differential diagnoses

  • Allergic conjunctivitis
  • Acute keratitis
  • Acute iritis/uveitis
  • Acute glaucoma

Complications

  • Corneal affectation, which could lead to perforation
  • Endophthalmitis

Investigations

  • Conjunctival swab for microscopy, culture and sensitivity

Management

Non-drug measures

  • Dark glasses for photophobia

Drug treatment

Antibiotic eyedrops or ointments

Chloramphenicol 0.5%

  • Apply one drop at least every 2 hours until infection is controlled then reduce frequency and continue for 48 hours after healing

Inclusion Conjunctivitis:

  • Sulphonamide drops or tetracycline drops or ointment

Epidemic keratoconjunctivitis:

  • Antibiotic drops to prevent secondary bacterial infection. (Chloramphenicol 0.5% drops
    • Adult and child over 2 years: apply every 4 hours for no more than 5 days)

Ophthalmia Neonatorum
Gentamicin sulfate 0.3% applied as stated above

Or:

Ofloxacin 0.3% solution applied as stated
above
Plus:
systemic cephalosporin e.g. ceftriaxone

  • Adult: 1 g every 12 hours intravenously for 7 days
  • Child: by intravenous infusion
    over 60 minutes

    • Neonates: 20-50 mg/kg
      once daily, by deep intramuscular injection, intravenous injection over 2-4
      minutes, or by intravenous infusion
    • 11 month – 12 years (body weight under 50 kg) 50 mg/kg once daily, up to 80 mg/kg in severe infections

Chlamydia
Systemic erythromycin

  • Adult and child over 8 years: 250 – 500 mg orally every 6 hours (or 500 mg – 1g every 12 hours)
    Child:

    • 1 month – 2 years: 125 mg orally every 6 hours; dose doubled in severe infections
    • 2-8 years: 250 mg 6 hourly;
    • 8-18 years: 250 – 500 mg 6 hourly; dose doubled in severe infections

Caution and contraindications

  • Steroid drops are absolutely contraindicated

Prevention

  • Wash hands thoroughly after any unhygienic procedure.
  • Avoid sharing towels used for cleaning face