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Conjunctivitis

  • Types of conjunctivitis: 

    • bacterial​

    • viral

    • allergic

    • cicatrising

    • chlamydial

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  • Bacterial

    • caused by staphylococcus, streptococcus, aemophilus​

    • symptoms

      • red, sticky eyes, mild discomfort (not pain), no change to visual acuity (sometimes reportedly blurred due to discharge)​

    • complications rare

    • treatment

      • majority of cases do not require treatment and resolve spontaneously in 5-7 days​

      • delayed antibiotic prescription may be offered

      • if given, frequent antibiotic drops e.g. chloramphenicol eyedrops given 

      • alternatively chloramphenicol ointment

      • 2nd line fusidic acid eye drops

      • lid hygiene

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  • Viral

    • caused by adenovirus​

    • symptoms

      • red eyes, watery discharge, mild discomfort, visual acuity normal unless corneal involvement​

    • associated with uper respiratory tract infection (sore throat, rhinorrhoea, cough)

    • examination

      • conjunctival injection (redness)

      • watery discharge

      • follicles (collections of lymphocyte cells) seen on the conjunctiva of the inside of the eyelids (tarsal conjunctiva) ​

    • infection may persist for weeks

    • treatment

      • lid hygiene​

      • occasionally antibiotic drops as prophylaxis against secondary bacterial infection (but usually self limiting) 

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  • Allergic

    • acute onset​

    • type I hypersensitivity reaction

    • bilateral red, itchy eyes with chemosis (conjunctival oedema i.e. swelling), vision preserved

    • can be treated with antihistamine eyedrops or oral antihistamine tablets; however often resolves without treatment

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  • Cicatrising

    • = conjunctiitis that leads to fibrosis (scarring) - this can lead to abnormal connectinos between the conjunctiva and the inner aspect of the eyelids​

    • causes​

      • microorganisms - trachoma

      • dermatological disease - Stevens-Johnson syndrome, mucous membrane pemphigoid, acne rosacea

      • allergic disease - chronic atopic kerato-conjunctivitis

      • physical - heat, chemicals, radiation​

      • iatrogenic - topical or systemic drugs

      • systemic disorders - IBD, Sjögren's disease

      • malignancy - SCC, sebaceous cell carcinoma​

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  • Chlamydial

    • classically uniocular conjunctivitis in a young male​

    • sexually transmitted

    • symptoms

      • conjunctival injection, watery discharge, sensation of grit or foreign body in eye​

      • visual acuity preserved

    • treatment​

      • oral antibiotics e.g. aithromycine or doxycycline

      • referral to sexual health clinic for STI screen

      • partner tracing + testing​

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