Bacterial conjunctivitis

Background

  • Often due to staphylococcus or streptococcus

Clinical Features

  • Painless, unilateral or bilateral mucopurulent discharge
    • Often causes adherence of the eyelids on awakening
  • Chemosis is common

Differential Diagnosis

Conjunctivitis Types

Evaluation

Workup

  • Eye exam
  • Fluorescein stain of cornea (especially in infants) to assess for corneal lesion
  • Culture: if severe

Evaluation

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

  • Treatment for bacterial organisms is targeted toward S. aureus, S. pneumoniae, H. influenzae, Pseudomonas, N. gonorrhea, C. trachomatis
  • Contact lens wearers should be given coverage for Pseudomonas with one of the fluoroquinolone drops

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

Disposition

  • Discharge with ophtho follow-up (if no improvement) in 3 - 4 days

See Also

References