Pharmacotherapeutic Options for Ophthalmic Conjunctivitis

A D Van Eyk

doi:10.4102/safp.v60i2.4827

Abstract

Conjunctivitis is a common eye condition involving inflammation and in some instances infection of the conjunctiva. In the majority of cases it is caused by adenoviruses and to a lesser extent bacteria. Conjunctivitis can also occur secondary to Chlamydial and Gonococcal infections and new-born infants can acquire it during the birthing process from infected mothers. Herpes simplex and Herpes zoster are the infective organisms also responsible for conjunctivitis while seasonal pollens are usually the cause for allergic conjunctivitis. Common symptoms and signs are redness, tearing, oedema of the eyelids, sensation of a foreign body and it may be accompanied by itching. Most often a purulent discharge and adherence of eyelids at awakening are indicators of a bacterial infection. Most of the uncomplicated acute cases are self-limiting. There is however a challenge in distinguishing between the various types of conjunctivitis due to the similarity in the symptoms and due to a lack of tests and prediction algorithms, thus antibiotic therapy is often incorrectly initiated. Treatment of acute uncomplicated conjunctivitis caused by adenoviruses and bacteria is mostly symptomatic. Topical eye drops and ointments are preferred to oral agents in the treatment of more severe bacterial and allergic conjunctivitis while oral agents are used in the treatment of conjunctivitis caused by Herpes simplex, Herpes zoster, Chlamydia trachomatis and Neisseria gonorrhoeae.

Highlights

Conjunctivitis is an inflammatory eye condition that involves the conjunctiva, a highly vascularised, thin and translucent membrane that covers the anterior portion of the sclera and the inside of the eyelids.[1,2,3,4,5,6,7] It presents as a red or pink eye due to the dilation of the blood vessels that leads to hyperaemia and oedema of the conjunctiva
Because of the difficulty in distinguishing between bacterial and viral conjunctivitis, in the majority of the cases, topical antibiotic therapy is initiated as there is a lack of tests or prediction algorithms available to confirm the diagnosis.[1,5,12,13]
The causative agents are either Staphylococcus aureus, Staphylococcus epidermis, Streptococcus pneumoniae or Haemophilus influenzae in adults and Haemophilus influenza, Streptococcus pneumoniae or Moraxella catarrhalis in children.[1,2,4,6,8,9,11,18,20,21]

Summary

Conclusion

Conjunctivitis is one of the most common eye disorders seen by health care providers at the primary level, and the two most common forms of infectious conjunctivitis are non-herpetic viral (adenovirus) and bacterial in nature. Treatment is usually topical eye drops or ointments except in the cases of herpes, chlamydial and gonococcal infections where topical, oral and in some instances IV or IM medications are indicated. I.e. acute, seasonal and perennial.[2,4,27] Presenting symptoms are itching, redness, eyelid oedema and watery discharge.[1,2,3,4,5,7,8,9,11,21] Patients should be instructed to avoid the offending allergen and encouraged to irrigate the eyes with saline or artificial tears. Treatment options include topical antihistamines, decongestants and mast cell stabilisers (Table I).[1,3,4,5,7,11,16,27] Topical decongestants should not be used long-term due to the risk of reactive hyperaemia.[11,15,16,27] Adverse effects of topical agents are usually transient stinging and in some instances CNS effects.[15,16] The use of non-sedating

Optometric Clinical Practice Guideline

Findings

19. Clinical Management Guidelines