Conjunctivitis – red eye
This is one of the commonest eye problems that usually present in general practice. The patients usually presented with red eye associated with feeling of eye discomfort. Some even described as sore eye. The patients usually complaint of watery eyes associated with sticky eye discharge mainly on waking up in the morning. On examination, there is present of enlarged papillae under the upper eyelid. Pre auricular lymph nodes may be enlarged however there is no change with vision.
There are few types of conjunctivitis. Infective conjunctivitis is caused by bacteria or viral. Ophthalmia neonatorum affected neonates. The other type is allergic conjunctivitis.
Clinically, infective conjunctivitis is difficult to distinguish from other type of conjunctivitis. Like I have told earlier, it usually caused by bacteria or viral infection. Symptoms mainly started in one eye. Over time, it will infect the other eye as well. Most of the time, the treatment is empirically, however if symptom does not resolved, eye swab culture and sensitivity should be taken to optimized treatment. The disease usually self limiting and will get better over time. The key is isolation so it does not spread to others. If symptom persist, antibiotic eye drops (e.g .: chloramphenicol eye drop 2 drops 3-4 times daily) will be prescribed up to 5 days.
Allergic conjunctivitis is due to exposure to allergens. Bilateral eye will be affected. The symptoms appear seasonally (e.g.: hay fever) or during contact with any allergen (e.g.: dust or animal fur). The patients will complaint of red and watery eyes. Photophobia might be present. Most of the time, there is also personal history or family history of atopy. Upon eye examination, follicles will be seen in the lower tarsal conjunctiva while ‘cobblestones’ will be found under the upper eyelid. As for management, topical or systemic antihistamine will be needed. For example piriton, loratadine and sodium chromoglycate eye drop. Topical steroids should be avoided due to long term complications of cataract, glaucoma or fungal infection. Persistent allergic conjunctivitis needs a referral to see ophthalmologist.
Ophtalmia neonatorum is seen in neonates (baby age less than 40 days). It is caused by Nisseria gonorrhea infections. It manifests as a purulent discharge from the eyes. Swab culture and sensitivity may be needed to determine the pathogen. Topical antibiotic is given for treatment. In few cases, ophthalmologist referral is needed for expert opinion and management.
Reference:
1. Oxford Handbook of General Practice. Oxford University Press. 2005.
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