Makindo Medical Notes

👁️ Conjunctivitis (inflammation of the conjunctiva) is one of the most common causes of red eye. ⏳ Most cases are benign and self-limiting (7–10 days), but persistence, pain, or visual loss warrant urgent referral. 🦠 Infective conjunctivitis is usually viral and does not routinely require antibiotics. ⚠️ Always ask about contact lens use — risk of Pseudomonas keratitis.

📖 About

• The conjunctiva = thin mucous membrane lining the eyelids + sclera.
• Highly vascular → easily inflamed, causing redness, discharge, irritation.
• Spread via fingers, towels, or respiratory droplets → good hygiene essential.

🧾 Aetiology

• 🦠 Viral: Adenovirus (most common), enterovirus, HSV.
• 🧫 Bacterial: Strep pneumoniae, Staph aureus, H. influenzae, Moraxella. Hyperacute = gonococcal (sight-threatening!).
• 🤧 Allergic: Hay fever, atopy, seasonal allergens. Drug-induced (e.g., chloramphenicol).
• 🌍 Chronic: Trachoma (Chlamydia trachomatis) → scarring, blindness in endemic regions.
• ⚠️ Other: Autoimmune (Stevens–Johnson, cicatricial pemphigoid).

🔎 Clinical Features

• ⏱️ Resolves spontaneously in 7–10 days (if simple infective).
• 👁️ Red/pink eye with gritty sensation.
• Bacterial: Mucopurulent discharge, “glued” eyelids on waking.
• Viral: Watery discharge, often following URTI; highly contagious.
• Allergic: Bilateral, intense itching, stringy discharge, seasonal recurrence.
• STI-related: Gonococcal → copious purulent discharge, rapid corneal ulceration. Chlamydial → chronic, follicles, preauricular lymphadenopathy.

🧪 Investigations

• Usually clinical diagnosis.
• Swabs/culture if: atypical, recurrent, severe, or non-resolving.
• NAATs if chlamydia/gonorrhoea suspected.
• Slit-lamp exam if keratitis, uveitis, or foreign body suspected.

💊 Management

• General Measures (all types): 🧼 Hand hygiene, avoid sharing towels, no contact lenses until resolved.
• Allergic conjunctivitis: ❄️ Cool compresses, lubricants, topical antihistamines (olopatadine, azelastine). Mast cell stabilisers (sodium cromoglicate) for recurrent cases.
• Infective conjunctivitis: 💧 Lubricants for comfort. Most adults = viral → no antibiotics. Children with mucopurulent discharge may receive chloramphenicol if severe.
• Bacterial (purulent): Chloramphenicol 0.5% drops q2h × 48h → then QDS until 48h after resolution. Alternative: Fusidic acid gel BD (esp. children or compliance issues).
• STI-related: 🚨 Ophthalmia neonatorum (gonococcal) → emergency admission. IV/IM ceftriaxone + topical therapy. Chlamydial → systemic azithromycin/doxycycline + sexual health referral.

🚩 Red Flags — Refer Ophthalmology Urgently

• 👓 Contact lens wearers (risk of pseudomonal keratitis).
• 🩸 Pain, photophobia, or ↓ vision (uveitis, keratitis).
• ⚠️ Copious purulent discharge (gonococcal).
• 🧪 Suspected STI-related conjunctivitis.
• Recurrent or persistent >10 days despite treatment.

📚 References

• NICE CKS: Infective Conjunctivitis
• RCOphth Guidelines