II. Epidemiology

  1. Transmission typically via direct contact with contaminated items (esp. fingers)
  2. Infectious for first 48 hours of treatment

IV. 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 and Eyelids in morning
  4. Significant irritation with stinging sensation or foreign body sensation
  5. Eyelid may appear puffy

V. Signs

  1. Variable Conjunctival injection
    1. Palpebral Conjunctiva is more affected than bulbar
  2. Lid edema
  3. No preauricular adenopathy
  4. No Corneal involvement
  5. Eyelid Edema
  6. Intact Visual Acuity

VI. Diagnosis

  1. Predictors of Bacterial Infection
    1. Copious Eye Discharge
    2. Eyes glued shut in morning
      1. Especially if both eyes glued shut (Odds Ratio: 15)
  2. Predictors of viral infection
    1. Itching eyes (if moderate to severe, likely Allergic Conjunctivitis)
    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 329:206-10 [PubMed]

VII. Complications

  1. Deeper eye involvement may occur in severe cases
  2. Blepharitis ("Granulated Eyelids")
    1. Seen in chronic Bacterial Conjunctivitis
    2. Colonization of lid margins by Staphylococcus aureus
  3. External Hordeolum (stye)

VIII. Course: Self-Limited

  1. Resolves in 2 weeks without treatment (65% improve within 2-5 days)
  2. Clears in 48-72 hours with treatment
  3. Serious complications are rare

IX. Lab: Eye Culture Indications

  1. Severe cases
  2. Immune compromised state
  3. Contact Lens use
  4. Newborns
  5. Failed initial treatment

X. Management

  1. Conditions requiring urgent ophthalmology referral
    1. Gonococcal Conjunctivitis
    2. Chronic or recurrent Conjunctivitis
    3. Conjunctivitis not improving after 7 days of treatment
  2. Protocol
    1. Consider observing without antibiotic therapy if no risk factors and have good follow-up
    2. Factors suggesting starting immediate antibiotics
      1. Healthcare workers (can not return to work until discharge ceases)
      2. Patients residing in health care facility or hospital
      3. Children attending daycare or school who cannot return until treatment started
      4. Immune compromised patient
      5. Uncontrolled Diabetes Mellitus
      6. Contact Lens use
      7. Dry Eyes
      8. Recent ophthalmic surgery
  3. Preparations
    1. See Topical Eye Antibiotic
    2. Course
      1. Typically 7 days has been used
      2. Short duration of 3-5 days is probably sufficient
    3. General Approach with First Line Agents (for low risk patients and infections)
      1. Daytime Agents
        1. Trimethoprim-Polymyxin B (Polytrim) solution 2 drops four times daily
        2. Avoid Sulfacetamide (low efficacy)
        3. Avoid Neomycin (Allergic Reaction is common in more than 25% after only 3 days of use)
      2. Nighttime agent (consider as soothing overnight management)
        1. Erythromycin 0.5% ointment nightly
    4. Broad Spectrum antibiotics for serious or refractory Bacterial Conjunctivitis
      1. Gentamicin (Gentak) 0.3% ointment or solution
      2. Tobramycin (Tobrex) 0.3% solution (ointment is not generic and is expensive)
      3. Ciprofloxacin (Ciloxan) 0.3% ointment or solution
      4. Ofloxacin (Ocuflox) 0.3% solution
    5. Direct treatment if specific Bacterial eye infection suspected
      1. Chlamydia Conjunctivitis
      2. Gonorrhea Conjunctivitis

XI. Resources (Include Patient Education)

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Ontology: Bacterial conjunctivitis (C0009768)

Definition (MSHCZE) Zánět spojivek (konjunktivitida), obv. oboustranný, vyvolaný bakteriemi, např. stafylokoky, streptokoky, Haemophilus influenzae. Nápadná hnisavá sekrece je u k. způsobené gonokoky (gonoblenorea), kde hrozí i šíření zánětu na rohovku s dalšími komplikacemi. Nespecifická k. se léčí obv. antibiotiky v kapkách a masti, léčba gonokokové k. musí být velmi energická. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Inflammation of the conjunctiva caused by a variety of bacterial agents.
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.
Concepts Disease or Syndrome (T047)
MSH D003234
ICD10 H10.0
SnomedCT 17482009, 193877001, 243462001, 243321006, 128350005
English Bacterial Conjunctivitides, Bacterial Conjunctivitis, Conjunctivitides, Bacterial, Conjunctivitides, Mucopurulent, Conjunctivitides, Purulent, Conjunctivitis, Bacterial, Conjunctivitis, Mucopurulent, Conjunctivitis, Purulent, Mucopurulent Conjunctivitides, Purulent Conjunctivitides, Purulent Conjunctivitis, Mucopurulent Conjunctivitis, BACT CONJUNCTIVITIS, CONJUNCTIVITIS BACT, CONJUNCTIVITIDES BACT, BACT CONJUNCTIVITIDES, Conjunctivitis, Bacterial [Disease/Finding], Conjunctivitis;bacterial, bacterial conjunctivitis, diseases eye pink, purulent conjunctivitis, disease pink eye, pink eye disease, Conjunctivitis bacterial NOS, conjunctivitis purulent, mucopurulent conjunctivitis (diagnosis), conjunctivitis mucopurulent, Purulent conjunctivitis (diagnosis), mucopurulent conjunctivitis, Conjunctivitis bacterial, Mucopurulent conjunctivitis, Purulent conjunctivitis, Mucopurulent conjunctivitis (disorder), Purulent conjunctivitis (disorder), Bacterial conjunctivitis (disorder), conjunctivitis; mucopurulent, mucopurulent; conjunctivitis, ophthalmia; purulent, purulent; ophthalmia, Mucopurulent conjunctivitis (disorder) [Ambiguous], Bacterial conjunctivitis
Dutch conjunctivitis bacterieel NAO, purulente conjunctivitis, conjunctivitis; mucopurulent, mucopurulent; conjunctivitis, oftalmie; purulent, purulent; oftalmie, Mucopurulente conjunctivitis, conjunctivitis bacterieel, Conjunctivitis, mucopurulente, Conjunctivitis, purulente, Bacteriële conjunctivitis, Conjunctivitis, bacteriële
French Conjonctivite bactérienne SAI, Conjonctivite bactérienne, Conjonctivite muco-purulente, Conjonctivite mucopurulente, Conjonctivite purulente
German Bindehautentzuendung bakteriell NNB, Mukopurulente Konjunktivitis, eitrige Konjunktivitis, Bindehautentzuendung bakteriell, Bakterielle Konjunktivitis, Konjunktivitis, bakterielle, Konjunktivitis, eitrige, Konjunktivitis, mukopurolente, Bakterielle Bindehautentzündung, Bindehautentzündung, bakterielle
Italian Congiuntivite batterica NAS, Congiuntivite purulenta, Congiuntivite mucopurulenta, Congiuntivite batterica
Portuguese Conjuntivite bacteriana NE, Conjuntivite purulenta, Conjuntivite bacteriana, Conjuntivite Bacteriana, Conjuntivite Mucopurulenta, Conjuntivite Purulenta
Spanish Conjuntivitis bacteriana NEOM, Conjuntivitis purulenta, conjuntivitis bacteriana (trastorno), conjuntivitis bacteriana, conjuntivitis mucopurulenta (concepto no activo), conjuntivitis mucopurulenta (trastorno), conjuntivitis mucopurulenta, conjuntivitis purulenta (trastorno), conjuntivitis purulenta, Conjuntivitis bacteriana, Conjuntivitis Bacteriana, Conjuntivitis Mucopurulenta, Conjuntivitis Purulenta
Japanese 細菌性結膜炎NOS, サイキンセイケツマクエン, サイキンセイケツマクエンNOS, 結膜炎-細菌性, 化膿性結膜炎, カノウセイケツマクエン, 粘液膿性結膜炎, 細菌性結膜炎, 結膜炎-化膿性, 結膜炎-粘液膿性
Swedish Bindhinneinflammation, bakteriell
Czech konjunktivitida bakteriální, Bakteriální konjunktivitida, Bakteriální konjunktivitida NOS, Hnisavá konjunktivitida
Finnish Bakteriaalinen sidekalvotulehdus
Russian KON"IUNKTIVIT SLIZISTO-GNOINYI, KON"IUNKTIVIT BAKTERIAL'NYI, BAKTERIAL'NYI KON"IUNKTIVIT, KON"IUNKTIVIT GNOINYI, БАКТЕРИАЛЬНЫЙ КОНЪЮНКТИВИТ, КОНЪЮНКТИВИТ БАКТЕРИАЛЬНЫЙ, КОНЪЮНКТИВИТ ГНОЙНЫЙ, КОНЪЮНКТИВИТ СЛИЗИСТО-ГНОЙНЫЙ
Korean 점액화농성 결막염
Croatian KONJUNKTIVITIS, BAKTERIJSKI
Polish Zapalenie spojówek bakteryjne
Hungarian bacterialis conjunctivitis k.m.n., bacterialis conjunctivitis, Purulens conjunctivitis
Norwegian Konjunktivitt, purulent, Mukopurulent konjunktivitt, Konjunktivitt, bakteriell, Purulent konjunktivitt, Bakteriell konjunktivitt, Konjunktivitt, mukopurulent