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By ULY CLINIC

 

Conjunctivitis

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Introduction

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This is an inflammation of the conjunctivae and one of the most common causes of red eyes. The cause of conjunctivitis may be bacterial, viral or allergy. Clinical features and treatment guideline depends on the type and cause of conjunctivitis. 

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Note:

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If conjunctivitis is due to an infection, counsel on the importance of frequent hand washing, use separate linen, towels and wash towels and avoid direct contact with infected materials or individuals

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Contacts lenses should not be worn in patients with conjunctivitis until the condition has resolved

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Allergic Conjunctivitis

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 Diagnostic Criteria

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  • Patients present with history of itching of eyes, sand sensation, and sometimes mucoid discharge  

  • When examined, 

  • the eyes may be normal or slightly red, 

  • Conjunctival swelling in severe cases, 

  • Limbal hyperpigmentation and papillae of the upper tarsal conjunctiva.

  • Normal iris, pupil and visual acuity.

  • Corneal complications in very advanced stages   

 

Non-Pharmacological Treatment

 

Treatment of allergic conjunctivitis depends on the severity of the condition and age of the patient. In mild cases where the eyes are white, 

  • Avoid allergens

  • Cold water compresses for 10 minutes four times a day

 

 Pharmacological Treatment

 

Adults and children > 6 years of age:

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  • Oxymetazoline 0.025% drops 6 hourly a maximum of 7 days

 If no response within 7 days, use mast cell stabilizers such as:

  • C: Sodium chromoglycate 2% eye drops, instill 6 hourly per day (Doctor initiated)

 Use may be seasonal (1–3 months) or long term. 

 

Children 2–6 years of age:

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  • Chlorpheniramine (PO) 0.1 mg/kg/dose 6–8 hourly

If no response within 7 days use

  • Sodium chromoglycate 2% eye drops, instill 6 hourly per day (doctor initiated)

  • Use may be seasonal (1–3 months) or long term for the prevention of further attack, depending on the patient’s exposure to the allergen. 

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Persistent allergic Conjunctivitis in adults and children of >2 years of age:

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For long term use:

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Children 2–6 years

  • Cetirizine (PO) 5 mg once daily

  • Use may be seasonal (1–3 months) or long term 

Children > 6 years of age and adults:

  • Cetirizine (PO) 5 mg once daily

  • Use may be seasonal (1–3 months) or long term 

 

NOTE: Do not give antihistamine to children under 2 years of age as its effectiveness at this age group has not been proven. 

 

Referral

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Refer to eye specialist for further specialized care in case of the following:

  • Moderate to severe allergic conjunctivitis 

  • No response

  • Persons wearing contact lenses

  • Children <2 years of age 

 

At the specialized centre, the following treatment may be added depending on the patient’s presentation: Short term steroid eye drops (in severe cases with involvement of the cornea, apart from mast cell stabilizers, give 

 

  • Dexamethasone 0.1%, 6 hourly for a maximum of 14 days.

OR 

  • Prednisolone 0.5%, 6 hourly for a maximum of 14 days. 

 In very severe form of allergic conjunctivitis, give steroid injection  

  • Triamcinolone acetonide 20 mg, subtenon injection, stat

OR 

  • Methylprednisolone sodium acetate 20mg, subtenon injection, stat  

 

Viral Conjunctivitis

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The commonest causative organism is adenovirus. It may be unilateral but usually bilateral 

 

Diagnostic Criteria

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  • It may be associated with upper respiratory tract infection

  • Presents with morning crusting and watery eye discharge

  • A burning, sandy or gritty feeling in the eyes  

  • Diffuse pink or red conjunctiva due to subconjunctival haemorraghes

  • Photophobia if the cornea is involved

  • Normal visual acuity

  • Preauricular lymphadenopathy

  • It appears in epidemics so there will be history of contact with patients with similar eye condition

  • It is usually is self-limiting but the irritation and discharge get worse on 3 – 5 days before getting better and symptoms can persist for 2–3 weeks.  

 

Non-Pharmacological Treatment

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  • Advise on correct cleansing or rinsing of eyes with clean water

  • Cold compresses for symptomatic relief

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Pharmacological Treatment 

 

Children > 6 years and adults

  • Oxymetazoline 0.025% eye drops, instill 1–2 drops 6 hourly for a maximum of 7 days.   

AND 

Children  

  • Paracetamol (PO) 10–15 mg/kg/dose 6 hourly when required. 

Adults  

  • Paracetamol (PO) 1g, 6 hourly when required

 

Referral

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Refer all patients to a centre with eye specialist if there is 

  • No response after 5 days

  • Unilateral red eye for more than one day

  • Suspected herpes conjunctivitis

  • Loss of vision

  • Irregular pupil

  • Haziness of cornea

  • Persistent painful eye 

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Note: Viral conjunctivitis is very contagious so patients and members of the family should be alerted

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Bacterial Conjunctivitis

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Purulent conjunctival inflammation caused by bacterial infection 

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Diagnostic Criteria

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  • It is characterized by:

  • Mucopurulent discharge from one or both eyes 

  • Sore, gritty or scratch eyes and swollen lids 

  • Conjunctiva redness more at the fornices

  • Eyelids may be swollen

  • Matting of eye lashes in the morning with eyelids stuck shut 

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Non-Pharmacological Treatment

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  • Educate patient on personal hygiene to prevent spread 

  • Educate patient correct application of ophthalmic ointment

  • To wash hands thoroughly before applying ophthalmic ointment

  • Not to share the ophthalmic ointment and drops

  • Eye swabs for Gram stain and for culture and sensitivity may be needed to tailor down treatment.   

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Pharmacological Treatment   

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  • Chloramphenicol 1%, ophthalmic ointment, applied 8 hourly for 5 days.    

OR  

  • Ciprofloxacin 0.3%, ophthalmic drops, instill 1 drop, 4 hourly for 2 days.

Then reduce frequency to 1 drop 6 hourly for 5 days  

OR  

  • Ofloxacin 0.3%, ophthalmic drops, instill 1 drop 4 hourly for 2 days.

Then reduce the frequency to 1 drop 6 hourly for 5 days   

AND  

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Children  

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  • Paracetamol (PO) 10–15 mg/kg/dose 6 hourly when required. Adults:  

  • Paracetamol (PO) 1 g 6 hourly when required. 

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Referral

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  • Refer to eye specialist if no improvement after 2 days of treatment

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Updated on, 2.11.2020

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References

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1. STG 

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