Makindo Medical Notes

Conjunctivitis (Pink Eye)

• Causes: Bacterial (S. aureus, H. influenzae, S. pneumoniae, Moraxella), viral (adenovirus), allergic, or irritative.
• Symptoms: Redness, itching, watery or purulent discharge, eyelid crusting, and discomfort.
• Treatment:
  • 👁️ Bacterial: Chloramphenicol 0.5% drops, 2–4×/day until 48h post-resolution (max 5 days).
  • 🦠 Viral: Self-limiting. Use lubricating drops + cool compresses.
  • 🌸 Allergic: Antihistamine/mast-cell stabiliser drops, allergen avoidance.
  • ⚠️ Herpetic: Immediate ophthalmology referral for antiviral therapy (aciclovir).
• Prevention: Good hand hygiene, avoid sharing towels/cosmetics, discourage eye-rubbing.

Keratitis (esp. Contact Lens Users)

• Causes: Pseudomonas aeruginosa, S. aureus, fungi, Acanthamoeba.
• Symptoms: Severe eye pain, redness, photophobia, blurred vision, tearing.
• Action: 🚨 Ophthalmology emergency – requires corneal scrape & targeted therapy. Broad-spectrum antibiotic (e.g., ciprofloxacin drops), antifungal, or anti-amoebic agents may be needed.

💡 Tip: Always ask about contact lens hygiene and swimming with lenses – major risk factors for Acanthamoeba keratitis.

Orbital vs. Periorbital Cellulitis

• Causes: Often spread from sinusitis; organisms include S. aureus, S. pneumoniae, H. influenzae, S. milleri.
• Symptoms: Painful, swollen red eye, fever, impaired ocular movement, possible proptosis.
• Treatment: 🚨 Medical emergency. Admit for IV antibiotics (Co-amoxiclav 1.2 g TDS). If penicillin allergy → consult Microbiology for IV alternatives.
• Investigations: CT orbits/sinuses. ENT referral if sinus disease present.

Endophthalmitis

• Causes: Post-op (esp. cataract surgery), post-intravitreal injection, or penetrating trauma. Pathogens: Staphylococcus, Streptococcus, Pseudomonas (trauma).
• Symptoms: Severe eye pain, redness, ↓ vision, discharge, photophobia.
• Treatment: 🚨 Ophthalmology emergency – urgent intravitreal antibiotics/antifungals ± vitrectomy. Systemic antibiotics may also be used.

General Supportive Care

• 🟠 Warm compresses to ease discomfort & aid discharge clearance.
• 💧 Lubricating/artificial tears for viral/allergic conjunctivitis.
• 🧼 Hygiene: handwashing, proper contact lens care, avoid eye rubbing.
• 🌸 Antihistamine drops for allergic conjunctivitis + allergen avoidance.

Common Therapies by Type

• 💊 Antibiotics: Chloramphenicol (bacterial conjunctivitis), ciprofloxacin drops (contact lens-related keratitis).
• 🦠 Antivirals: Topical/systemic aciclovir for HSV keratitis/conjunctivitis.
• 🍄 Antifungals: Topical amphotericin or natamycin for fungal keratitis.
• 🪱 Anti-parasitics: Acanthamoeba → intensive topical antiseptics (chlorhexidine, PHMB).

Complications & Referral

• 🚨 Immediate ophthalmology referral: Severe pain, ↓ visual acuity, suspected herpetic keratitis, corneal ulcers, orbital cellulitis.
• ⚠️ Complications: Corneal scarring & vision loss (keratitis), panophthalmitis (endophthalmitis), cavernous sinus thrombosis (orbital cellulitis).