Conjunctivitis

What is conjunctivitis?

Inflammation of the conjunctiva (clear thin layer covers eye and inner eyelid)

Differentiate acute vs. chronic red eye. Which one is more likely conjunctivitis?

acute: short term, more likely conjunctivitis, self-limiting (7 days)

chronic: long-term, pre-existing condition, less likely conjunctivitis, potential self-care)

What are red flag symptoms?

pain

purulent discharge

sudden onset (preceded by trauma)

reduced vision (not improved by blinking)

contact lens wear

fever and swollen eyelid → cellulitis

Why does the eye become red?

blood vessels in conjunctiva become inflammed

What is the most common cause of conjunctivitis? What are other causes?

viral

bacteria, allergy

What are common symptoms associated with conjunctivitis?

redness AND discharge (crust, flaky)

no threat to vision and no pain!

What is the difference between bacterial, viral and allergic conjunctivitis?

bacterial: redness, bilateral, purulent discharge, highly contagious

viral: adenoviral, itching, burning, one eye then other, watery-mucus discharge, contagious

allergic: itching, watering, history of allergy, water discharge

What are self-care options for bacterial, viral and allergic conjunctivitis?

bacterial: topical antibiotics, lid hygiene

viral: lubricants, cold compress

allergic: cold compress, topical allergy meds, lubrication, remove pathogen

Which of the following are self-limiting? bacterial, viral, allergic

bacterial and viral

How does bacterial conjunctivitis present in adults?

thick purulent discharge throughout the day

often in those living in community homes

caused by S. Aureus or secondary exposure to strep A

How does bacterial conjunctivitis present in children?

S aureus, Strep pneumoniae, H. influenzae

Same presentation as adults

More common in children than adults

What are nonpharm treatments for bacterial conjunctivitis?

self-limiting → prevent spread

warm/cold compress

avoid contact lens use

What are the pharmacological treatment for bacterial conjunctivitis?

antibiotic eye drops/ointment

erythromycin 5mg/g ophthalmic ointment 0.5 in QID 5-7 days

trimethoprim-polymyxin B 0.1%-10,000 units/mL drops 1-2 drops QID 5-7 days

OTC polysporin eye drops 4x/day (cause stinging)

Tobramycin 0.3% ophthalmic solution (no sting)

How does viral conjunctivitis present?

caused by adenovirus

may follow upper respiratory tract infection

watery discharge, burning gritty feeling in one eye

patients may report pus but its just morning crusting + watery discharge

swollen/tender preauricular nodes

What are nonpharm treatment options for viral conjunctivitis?

self limiting

lubrication w/ artificial tears

cold compress

OTC or RX topical antibiotics will not help

What are some pharm treatments for viral conjunctivitis?

povidone-iodine 5% within 3 days of infection to reduce pathogen load (stings and causes pain, not good for children)

mild steroid for symptoms (lotemax, FML QID 5-7 days)

What symptoms indicate the need for topical antibiotics?

gluing of eyelids

no itch

no pre-auricular lymphadenopathy

How does treatment differ for someone who wears contact lenses?

need stronger antibiotic

What is complicated viral conjunctivitis?

antibiotics do not help

visual disturbances, significant inflamation, post-viral inflammation and ocular surface dryness (weeks)

What is a newer treatment option for conjunctivitis?

hypochlorous acid

natural bactericidal properties, non-toxic, reduce bacterial load, use for bacterial and viral

How does allergic conjunctivitis present? What are some red flags?

itching and watering

red flags: photophobia, pain, no improvement on antihistamines, lid swelling

What is the standard treatment for allergic conjunctivitis?

topical ophthalmic agents

standard of care: dual activity agents (antihistamines/mast cell stabilizers) → issue with cost

What are pharm treatment options for allergic conjunctivitis?

antihistamine/decongestant drops 1-2 drops QID

olopatadine 0.1% BID OR olopatadine 0.2% QID

When is it okay to return to school/work?

24h after topical therapy

safer approach: stay home until no more discharge