Taking a detailed history will assist with differential diagnosis and enable serious pathologies to be discounted see Box 2. Red flags necessitating referral or additional actions are outlined in Table 1. Contact lens wearers and patients with pre-existing eye conditions, such as glaucoma, can be referred to optometrists for initial investigation.
Children aged under two years, as well as pregnant or breastfeeding mothers, can be reviewed by a GP. It is important to remind patients that they should not drive or operate machinery unless vision is clear. If supplied with chloramphenicol, patients should be advised not to restart wearing lenses for 24 hours after completing their course of treatment. Systemic absorption of the drug can be reduced by employing punctual occlusion after administration i.
The choice between drops and ointment depends on patient preference. Some feel that ointment is easier to administer as they can see what they are applying.
The texture of ointment can also soothe a gritty eye. A patient may be concerned at the need to use drops every two hours initially. Risk of complications e. Any patient who has not recovered after 14 days of conservative management or failed a course of chloramphenicol should be referred to their GP for management. Access provided by. Bacterial conjunctivitis: diagnosis and management Bacterial conjunctivitis is a common presentation in community pharmacy so it is important to be able to recognise signs and symptoms, as well as identify causes and risk factors for all types of infection.
Box 1: Physical examination of the conjunctiva The conjunctiva should be inspected in a well-lit area or with a pen torch, with washed and disinfected hands. Box 2: Questions to ask when taking a history from a patient with suspected bacterial conjunctivitis When did the symptoms start?
Which eye or eyes are affected? Was one eye affected first? Is there any associated pain, soreness or gritty feeling in the eyes? Is there any associated itching?
Is the vision blurred or altered in any way? Can the discharge be described? It can be difficult to differentiate from bacterial conjunctivitis and they can coexist as viral conjunctivitis with bacterial superinfection. The RPS Adenodetector can be used to identify some strains of adenvirus responsible for infection. On the other hand, a history of mucopurulent discharge with "gluing" of the eyelids in the morning is predictive of bacterial conjunctivitis. Almost all cases of acute bacterial conjunctivitis are self-limited and will clear within 10 days without treatment.
However, there are some more virulent organisms which may go on to cause chronic colonization and symptoms. Furthermore, antibiotic treatment has been shown to decrease the duration of symptoms and speed the eradication of microorganisms from the conjunctival surface. Bacterial conjunctivitis is a contagious condition, so patients are instructed in proper hygiene and hand washing. The exact period of time of contagion cannot be predicted and the amount of time suggested varies, with a recent survey of ophthalmologists recommending 1 - 3 days away from work or until the infection clears.
Supportive therapy for conjunctivitis consists of cool compresses and artificial tears two-six times daily. Antibiotics may lead to quicker clinical and microbiological remission compared with placebo, at least in the first days of therapy.
This may result in decreased transmission of the disease and lower incidences within the population. Many antibiotics have been shown to be equivalent in the treatment of routine cases, and therefore the choice of antibiotics is often guided by cost, availability, and risk of side effects.
For Neisseria gonorrhoeae and Chlamydia trachomatis, systemic antibiotics are necessary as follows:. Since the vast majority of cases run a benign course, most patients are given medication and then told to return for follow-up only if there is worsening or no improvement in symptoms. Patients diagnosed with Chlamydia and Neisseria gonorrhoeae need to inform their partners and sexual contacts about their diagnosis so that they can be treated and re-infection avoided.
Create account Log in. Main page. Areas that light up with the dye can be a sign of corneal abrasion or may show a dendritic pattern often seen with herpes simplex eye infections.
The dye can also make it easier to locate a foreign body within the eye. Fluorescein is placed in your eye by having you blink onto a strip of dye-coated paper or by using eye drops and then use a slit lamp during this procedure to look at the eye. Altogether, the test takes only minutes to perform. At first, the whites of your eye will take on a yellow color but natural tears wash out the fluorescein over minutes to hours.
Any fluorescein that touches the skin around the eye could stain your skin for a day or two. Slit Lamp Examination. A more formal eye exam may be performed using a slit lamp. This is essentially a microscope that shines a thin beam of light into your eye. Your healthcare provider will use different lenses to evaluate the front chambers as well as the back chambers of your eye.
This equipment is most often found in an ophthalmologist or optometrist's office but some primary care offices, urgent care clinics, and the emergency department may also have access to a slit lamp. Lab testing can improve the accuracy of the diagnosis and may help to guide more effective treatments. Many healthcare providers often treat based on their clinical exam alone.
Bacterial conjunctivitis may require antibiotics, but viral infections are self-limited and heal on their own. The gold standard for diagnosing any infection is culture. Not only will the causative bacteria be identified, but it can then be tested against different antibiotics to show which ones are most effective.
For conjunctivitis, a sample of tears or other ocular discharge can be collected with a swab and sent to the laboratory. The problem with cultures is that it can take days to get results. That is too long to wait for treatment. Unless you have had resistant or recurrent infections, cultures are rarely used to diagnose conjunctivitis.
PCR Testing. Polymerase chain reaction PCR is a more advanced technique that uses DNA from a sample to see if an infection is present. Unlike traditional culture, it cannot check for antibiotic susceptibility. When it comes to conjunctivitis, PCR can be used to screen for both bacteria and viruses.
The most common bacteria screened are chlamydia and gonorrhea. Adenoviruses and herpes simplex viruses also have PCR tests available. The results are often available within 24 hours. Rapid Adenovirus Screening. While PCR can speed up the process, it still does not allow healthcare providers to make a diagnosis at the time of your visit.
That could mean a delay in treatment. A rapid point-of-care test is now available. It screens for all serotypes of adenovirus and can be run in your healthcare provider's office.
In 10 minutes, you will know if you have the virus. In this case, you do not need antibiotics and can save on the cost of treatment. Unfortunately, not all offices offer the test. If your eye is red due to exposure to a chemical irritant and you are in pain, go to the nearest emergency room.
Often, your ophthalmologist can diagnose conjunctivitis simply by examining your eye. Based on your symptoms, he or she can usually determine whether the inflammation is due to a viral or bacterial infection.
He or she may perform the following tests to confirm a diagnosis:. Your ophthalmologist can rule out many causes of conjunctivitis simply by asking about your symptoms and how they came about. Most of the time, your doctor can diagnose conjunctivitis by using a slit lamp—an instrument that consists of a microscope and a high-energy beam of light. During a slit-lamp exam, your ophthalmologist shines a thin beam of light into your eye. This beam allows your doctor to examine the entire eye, including the conjunctiva; the sclera, or the white of the eye; the iris; and the cornea.
For a more detailed look at the eye, your doctor may put a drop of a yellow dye called fluorescein into your eye, which allows him or her to see any damage to the surface of the eye. Doctors also check to see if conjunctivitis has affected your vision by conducting a visual acuity test. This test checks to see how well you can read letters or symbols from 20 feet away, while covering one eye at a time.
If you have had conjunctivitis for more than two or three weeks and it has not gone away on its own or with the help of home treatments , your doctor may want to perform an eye culture. During this test, your doctor takes a sample of the cells on the inside of your eyelids with a cotton swab and sends it to a laboratory to be examined by a pathologist.
A pathologist, who studies diseases under a microscope, can determine whether your conjunctivitis is caused by viruses or bacteria. This helps your doctor determine the most effective treatment. We can help you find a doctor.
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