Conjuncitivitis

Question 1

Define Conjunctivitis

Answer 1

Means inflammation of the conjunctiva

The conjunctiva is the mucous membrane that lines the inside surface of the lids and covers the surface of the globe up to the limbus (junction of the sclera and cornea). It is the most likely diagnosis in a patient with a red eye and a discharge.

Question 2

Types of Conjunctivitis

Answer 2

Bacterial Conjunctivitis
Viral Conjunctivitis
Allergic Conjunctivitis
Noninfective Nonallergic Conjunctivitis

Question 3

Pathophysiology of Bacterial Conjunctivitis

Answer 3

Common organisms:

• Staph aureus
• Strep pneumoniae
• Haemophilus influenzae

Highly contagious and spread by direct contact

Question 4

Clinical Presentation of Bacterial Conjunctivitis

Answer 4

Patients typically complain of redness and discharge in one eye, although it can be bilateral. The discharge of bacterial conjunctivitis is thick and globular (yellow, green or white) continuing throughout the day. The affected eye is often stuck shut.

Question 5

Management of Bacterial Conjunctivitis

Answer 5

In mild cases, antiseptic eye drop can be used:
- Propamidine 0.1% eye drops

In severe cases, use:

• Chloramphenicol 0.5% eye drops OR
• Framycetin 0.5% eye drops

Question 6

Prognosis of Bacterial Conjunctivitis

Answer 6

Many cases will spontaneously remit within 5 days, however symptoms may last up to 14 days if untreated. A delayed prescription may be appropriate.

Question 7

Pathophysiology of Viral Conjunctivitis

Answer 7

Commonly caused by adenovirus. It may be part of a viral prodrome followed by adenopathy, fever, pharyngitis and URTI, but it may be standalone.

Question 8

Clinical Presentation of Viral Conjunctivitis

Answer 8

Typically presents with conjunctival injection, excessive watering and itching. The second eye usually becomes involved within 24-48 hours. Shows a fine diffuse pinkness of the conjunctiva.

Question 9

Management of Viral Conjunctivitis

Answer 9

No specific therapy but symptomatic treatment with:
- Topical antihistamines/decongestants
OR
- Lubricating agents.

Question 10

Prognosis of Viral Conjunctivitis

Answer 10

Symptoms get worse over the first 3-5 days, with very gradual resolution over 2-3 weeks

Question 11

Pathophysiology of Allergic Conjunctivitis

Answer 11

A relatively benign ocular disease condition that does not threaten vision. Caused by an allergy, most commonly hay fever.

Question 12

Clinical Presentation of Allergic Conjunctivitis

Answer 12

Primarily a disease of young adults, average age of 20 years, with symptoms decreasing with age. Approximately 50% have a personal or family history of allergic conditions.

Classically presents with eyelid and conjunctival erythema and swelling, almost always bilateral. The patient will complain of itching, tearing, conjunctival oedema, hyperaemia/injection, watery discharge, blurring and photophobia.

Question 13

Management of Allergic Conjunctivitis

Answer 13

• Topical antihistamines/vasoconstrictors
• Mast cell stabilisers (sodium cromoglycate drops)
• A combination of both
• Topical steroids (severe)