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Bacterial Conjunctivitis

Bacterial conjunctivitis

What is it?
In normal hosts, bacterial conjunctivitis is usually a benign, self-limited and very rare infection caused by organisms susceptible to a wide variety of antibiotics. But in abnormal hosts—neonates, ocular trauma or surgery, contact lens wear, immunocompromised states—it can be a virulent process that threatens vision and even life.

In neonates, the major concern is gonococcal conjunctivitis. Other rapidly necrotizing agents, in adults, are pseudomonas, proteus, Bacillus cereus, and the parasite acanthamoeba.

The management of red eye in neonates is a special problem. Infectious conjunctivitis occurs in 6% of newborns ("ophthalmia neonatorum").

Causes are Chlamydia, Neisseria gonorrhoeae, other bacteria, or herpes simplex. It may be a manifestation of systemic infection. Neglected, it can lead to blindness.

How does it present?
The patient complains of soreness, tightness, and heat in and around the affected eye. The conjunctiva is fiery red, boggy, and dripping with a thick, yellow pus. The eyelids are swollen.

What to do?
Consult an ophthalmologist promptly if the host is abnormal (including neonates) or if vision is depressed. Otherwise, treat empirically with topical sulfacetamide 10%, trimethoprim, aminoglycosides, or fluoroquinolones.

Be sure to demonstrate to the patient or a caregiver the proper and improper ways to instill eyedrops. Here is the proper way to instill eye drops.

Here are the choices of medications:

  • Sulfacetamide 10%
    Pros: broad spectrum coverage, inexpensive
    Cons: occasional contact allergy causing contact dermatitis of eyelids; very rare allergic (Stevens-Johnson) reaction; ineffective against rare virulent gram-negative organisms.
  • Trimethoprim/polymixin B
    Pros: broad spectrum coverage
    Cons: expensive
  • Aminoglycosides (gentamicin, tobramycin eyedrops or ointment)
    Pros: broad spectrum coverage; effective against most gram-negative species
    Cons: expensive, can cause keratitis
  • Fluoroquinolones (ciprofloxacin, ofloxacin, norfloxacin)
    Pros: broad spectrum coverage; effective against most gram-negative species
    Cons: very expensive
If there is no improvement within three days of starting treatment, or if there is worsening within several days, refer to an ophthalmologist.

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