Conjunctivitis

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Background

  • Most common cause of acute red eye
  • Viral infection is usual etiology

Conjunctivitis Types

Clinical Features

  • Injected conjunctiva with perilimbal sparing
  • Rarely painful; more irritated

Differential Diagnosis

Unilateral Red Eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

Conjunctivitis with limbus sparing
  • Typically clinical

Clinical diagnosis of conjunctivitis

Conjunctivitis
Bacterial Viral Allergic
Bilateral 50% 25% Mostly
Discharge Mucopurulent Clear, Watery Cobblestoning, none
Redness Yes Yes Yes
Pruritis Rarely Rarely Yes
Additional Treatment: Antibiotics Treatment: Hygiene Seasonal

Management

  • Viral infections - most common cause of conjunctivitis, but difficult to differentiate viral from bacterial
  • Many clinicians treat all presentations as bacterial conjunctivitis
  • Treatment considerations:
    • Ointments - soothing effect, but interfere with vision
    • Drops - no interference with vision

Antibiotics for Bacterial Causes

Bacterial Conjunctivitis

These options do not cover gonococcal or chlamydial infections

  • Polymyxin B/Trimethoprim (Polytrim) 2 drops every 6 hours for 7 days OR
  • Erythromycin applied to the conjunctiva q6hrs fir 7 days OR
  • Levofloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Moxifloxacin 0.5% ophthalmic 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Gatifloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN 1 drop every 6 hours for 5 days OR
  • Azithromycin 1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 days

Chlamydial

  • Doxycycline 100mg BID for 7 days OR
  • Azithromycin 1g (20mg/kg) PO one time dose
  • Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days
    • Disease manifests 5 days post-birth to 2 weeks (late onset)

Gonococcal

  • Dual treatment for Chlamydia is recommended with azithromycin
  • Ceftriaxone 1g IM one dose PLUS
  • Azithromycin 1g PO one dose
  • Newborn Treatment:
    • Prophylaxis: Erythromycin ophthalmic 0.5% x1
    • Disease manifests 1st 5 days post delivery (early onset)
    • Treatment Ceftriaxone 25-50mg IV or IM, max 125mg

Contraindicated

  • Corticosteroids have no benefit and can cause sight threatening injuries, especially in HSV or fungal causes of red eye
  • Eye patching thought to exacerbate the infection

Disposition

  • Outpatient treatment

See Also

References

  • Mahmood, Narang. Diagnosis & management of acute red eye. Emerg Med Clin N Am 2008;26