Introduction
The commonest cause of a red eye is infective conjunctivitis, which could be caused by bacteria or viruses.
Conjunctivitis occurs when the conjunctiva of the eye becomes inflamed.
Clinical features
- Red eye (generalized)
- Eye discharge: purulent or catarrhal, worse on waking from sleep
- Eye discomfort: grittiness
- Photophobia: mild
- Swollen eyelids in ophthalmia neonatorum
Aetiology
- Staphylococcus aureus,
- Pneumococcus
- Haemophillus influenza,
- Ophthalmia neonatorum
- Gonococcus
- TRIC agent (chlamydia)
- Adenovirus: Epidemic
- keratoconjunctivitis
(‘Apollo’)
Differential diagnoses
- Allergic conjunctivitis
- Acute keratitis
- Acute iritis/uveitis
- Acute glaucoma
Complications
- Corneal affectation, which could lead to perforation
- Endophthalmitis
Investigations
- Conjunctival swab for microscopy, culture and sensitivity
Management
Non-drug measures
- Dark glasses for photophobia
Drug treatment
Antibiotic eyedrops or ointments
Chloramphenicol 0.5%
- Apply one drop at least every 2 hours until infection is controlled then reduce frequency and continue for 48 hours after healing
Inclusion Conjunctivitis:
- Sulphonamide drops or tetracycline drops or ointment
Epidemic keratoconjunctivitis:
- Antibiotic drops to prevent secondary bacterial infection. (Chloramphenicol 0.5% drops
- Adult and child over 2 years: apply every 4 hours for no more than 5 days)
Ophthalmia Neonatorum
Gentamicin sulfate 0.3% applied as stated above
Or:
Ofloxacin 0.3% solution applied as stated
above
Plus:
systemic cephalosporin e.g. ceftriaxone
- Adult: 1 g every 12 hours intravenously for 7 days
- Child: by intravenous infusion
over 60 minutes- Neonates: 20-50 mg/kg
once daily, by deep intramuscular injection, intravenous injection over 2-4
minutes, or by intravenous infusion - 11 month – 12 years (body weight under 50 kg) 50 mg/kg once daily, up to 80 mg/kg in severe infections
- Neonates: 20-50 mg/kg
Chlamydia
Systemic erythromycin
- Adult and child over 8 years: 250 – 500 mg orally every 6 hours (or 500 mg – 1g every 12 hours)
Child:- 1 month – 2 years: 125 mg orally every 6 hours; dose doubled in severe infections
- 2-8 years: 250 mg 6 hourly;
- 8-18 years: 250 – 500 mg 6 hourly; dose doubled in severe infections
Caution and contraindications
- Steroid drops are absolutely contraindicated
Prevention
- Wash hands thoroughly after any unhygienic procedure.
- Avoid sharing towels used for cleaning face