bacterial conjunctivitis

Introduction

see conjunctivitis

Classification

• acute bacterial conjunctivitis
• hyperacute bacterial conjunctivitis due to Neisseria

Etiology

• Staphylococcus aureus (most common)
• Streptococcus pneumoniae
• Haemophilus
• Pseudomonas in contact lens wearers

Epidemiology

• highly contagious
• spread by person-to-person contact or through contact with contaminated surfaces

Clinical manifestations

• acute bacterial conjunctivitis
  • most commonly present after several days of symptoms
  • unilateral* diffuse conjunctival redness & discharge
  • thick yellow or green discharge
  • may awaken with eyelids stuck together
  • visual blurring that improves with blinking
  • overt changes in visual acuity do not occur
• hyperacute bacterial conjunctivitis due to Neisseria
  • sudden onset
  • profuse purulent discharge
  • diffuse bright red conjunctival hemorrhage
  • rapid progression to vision loss

* bilateral involvement may occur

Differential diagnosis

• hyperacute bacterial conjunctivitis due to Neisseria
  • copious purulent discharge
  • Keratitis, iritis, & scleritis do not cause copious purulent drainage

Management

• acute bacterial conjunctivitis
  • frequently self-limiting
  • antibiotic eye drops is associated with modestly improved rates of clinical & microbiological remission; NNT = 7
    • choice of antibiotic is generally empiric
      • trimethoprim-polymyxin B ophthalmic
      • fluoroquinolone ophthalmic if patient wears contact lens (Pseudomonas)
• hyperacute bacterial conjunctivitis due to Neisseria
  • emergency ophthalmology consult, hospitalization
  • both topical & systemic antibiotics indicated

More general terms

• conjunctivitis