Ophthalmology Book

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Bacterial Conjunctivitis

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  1. Epidemiology
    1. Transmission
      1. Infectious for first 48 hours of treatment
  2. Causes
    1. Newborns
      1. Chlamydial Conjunctivitis
      2. Gonorrheal Conjunctivitis
      3. See HSV Conjunctivitis in Viral Conjunctivitis
    2. Children
      1. Streptococcus Pneumoniae (*)
      2. Haemophilus Influenzae (*)
      3. Staphylococcus species
      4. Moraxella species
    3. Adults
      1. Staphylococcus aureus (*)
      2. Staphylococcus epidermidis
      3. Streptococcus species
      4. Escherichia coli
      5. Pseudomonas species
      6. Moraxella species
      7. Gonorrheal Conjunctivitis (Neisseria Gonorrhea)
  3. Symptoms
    1. Sudden onset
      1. Unilateral
      2. Progresses to other eye in 2-5 days
    2. Mucopurulent discharge
      1. Copious gray, yellow, or green discharge
      2. Consider Gonococcal Conjunctivitis (excessive pus)
    3. Matting of lashes in morning
    4. Significant irritation
      1. Foreign body sensation
    5. Eyelid may appear puffy
  4. Signs
    1. Variable Conjunctival injection
      1. Palpebral Conjunctiva is more affected than bulbar
    2. Lid edema
    3. No preauricular adenopathy
  5. Diagnosis
    1. Predictors of bacterial infection
      1. Eyes glued shut in morning
        1. Especially if both eyes glued shut (odds ratio: 15)
    2. Predictors of viral infection
      1. Itching eyes
      2. Prior episodes of Conjunctivitis
    3. Efficacy
      1. Eyes itch and not glued shut: 4% bacterial
      2. Glued shut, no itch, no prior history: 77% bacterial
    4. References
      1. Rietveld (2004) BMJ 329:206
  6. Complications
    1. Blepharitis ("Granulated Eyelids")
      1. Seen in chronic bacterial Conjunctivitis
      2. Colonization of lid margins by Staphylococcus aureus
    2. External Hordeolum (stye)
  7. Course: Self-Limited
    1. Resolves in 2 weeks without treatment
    2. Clears in 48-72 hours with treatment
  8. Management
    1. Conditions requiring urgent ophthalmology referral
      1. Gonococcal Conjunctivitis
      2. Chronic or recurrent Conjunctivitis
    2. Preparations
      1. General Approach with First Line Agents
        1. Daytime Agents
          1. Trimethoprim/Polymyxin (Polytrim) drops qid x5-7d
          2. Avoid Sulfacetamide (low efficacy)
          3. Avoid Neomycin (Allergic Reaction is common)
        2. Nighttime agent
          1. Erythromycin ointment qhs 7-10 days
          2. Polysporin ointment qhs x7-10 days
      2. Broad Spectrum
        1. Tobramycin
        2. Gentamicin
        3. Norfloxacin
  9. Resources (Include Patient Education)
    1. See Conjunctivitis Resources

Bacterial conjunctivitis (C0009768)

Definition (MSH)Purulent infections of the conjunctiva by several species of gram-negative, gram-positive, or acid-fast organisms. Some of the more commonly found genera causing conjunctival infections are Haemophilus, Streptococcus, Neisseria, and Chlamydia.
Definition (NCI)Inflammation of the conjunctiva caused by a variety of bacterial agents.
ConceptsDisease or Syndrome (T047)
MSHD003234
EnglishBACT CONJUNCTIVITIDES, BACT CONJUNCTIVITIS, Bacterial Conjunctivitides, Bacterial conjunctivitis, CONJUNCTIVITIDES BACT, CONJUNCTIVITIS BACT, Mucopurulent Conjunctivitides, Mucopurulent Conjunctivitis, Purulent Conjunctivitides, Purulent Conjunctivitis
Spanishconjuntivitis bacteriana, conjuntivitis mucopurulenta, conjuntivitis purulenta
Parent ConceptsConjunctivitis (C0009763), Eye Infections, Bacterial (C0015404), Bacterial Infections (C0004623), Infectious Disorder by Site (C1334175), Unspecified acute conjunctivitis (C0155141), Infective conjunctivitis (C0497209), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesCOSTAR, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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