By Watkins, Jean
AT A GLANCE BACTERIAL CONJUNCTIVITIS
Presentation
* Conjunctivitis is inflammation of the conjunctiva caused by bacteria, virus or allergy or associated with foreign body.
* Bacteria involved are commonly Staphylococcus, Streptococcus pneumoniae or Haemophilus influenza.
* More often Gram-negative bacteria in patients with contact lens.
* Eye feels gritty (allergic conjunctivitis is itchy).
* Watering of the eye discharge may be yellow/white and mucopurulent.
Management
* Check to exclude foreign body.
* May resolve without treatment.
* Avoid spread to contacts.
* Swab from discharge for culture and sensitivities.
* Topical chloramphenicol or gentamicin eye drops.
* Azithromycin twice daily for three days may be helpful.
* Gonococcal and chlamydia conjunctivitis requires topical and systemic antibiotics. This is likely to be sexually transmitted and so a full check of patient and contacts would be required.
Conjunctivitis causes watering and discharge from the eye
ACUTE ANTERIOR UVEITIS (IRITIS)
Presentation
* Painful red eye – usually unilateral.
* Photophobia and watering of the eye – not mucopurulent.
* Usually occurs after the age of 20. Usually idiopathic and may have recurrent episodes.
* May be associated with HLA-B27, herpes zoster, ankylosing spondylitis, inflammatory bowel disease, sarcoidosis, reactive arthritis or reaction to drugs.
* Irregular, poorly reactive constricted pupil as the condition develops.
Management
* Patients should be referred urgently to the ophthalmic unit for slit lamp examination, fundoscopy, measurement of intraocular pressures and check of visual acuity.
* Specialist advice regarding mydriatics and cycloplegics such as cyclopentolate or homatropine eye drops. Prednisolone eye drops.
As acute anterior uveitis develops, the pupil becomes constricted
Contributed by Dr Jean Watkins, a sessional GP in Hampshire
Copyright Haymarket Business Publications Ltd. Jan 25, 2008
(c) 2008 GP. Provided by ProQuest Information and Learning. All rights Reserved.