Conjunctivitis which antibiotic

Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. Conjunctivitis is commonly caused by bacteria and viruses. Neisseria infection should be suspected when severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate three to five days postpartum.

Conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is usually self-limited. Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis. Treatment requires good eyelid hygiene and the application of topical antibiotics as determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen exposure.

This condition is generally treated with topical antihistamines, mast-cell stabilizers or anti-inflammatory agents. The conjunctiva is a thin, translucent, relatively elastic tissue layer with both bulbar and palpebral portions. The bulbar portion of the conjunctiva lines the outer aspect of the globe, while the palpebral portion covers the inside of the eyelids.

Underneath the conjunctiva lie the episclera, the sclera and the uveal tissue layers Figure 1. Red eye is the most common ocular problem seen by primary care physicians. Bacterial e. Dry eye. Toxic or chemical reaction. Contact lens use. Occult conjunctival neoplasm. Foreign body. Recurrent epithelial erosion.

Lagophthalmos with globe exposure. Molluscum contagiosum. Preseptal and orbital cellulitis. Idiopathic orbital inflammation pseudotumor. The inflammation can be hyperacute, acute or chronic in presentation and infectious or noninfectious in origin. Conjunctivitis is the most common cause of red eye. Most frequently, conjunctivitis and thus red eye is caused by a bacterial or viral infection.

Sexually transmitted diseases such as chlamydial infection and gonorrhea are less common causes of conjunctivitis. However, these infections are becoming more prevalent and are important to recognize because of their significant associated systemic, ocular and social implications. Ocular allergy in its many forms is one of the major causes of chronic conjunctivitis.

Blepharitis inflammation of the eyelid margin , dry eye and the prolonged use of ophthalmic medications, contact lenses and ophthalmic solutions are also relatively frequent causes of chronic conjunctival inflammation.

This article highlights key features in the clinical history and ocular examination that can help family physicians to formulate a differential diagnosis and a management plan for patients with conjunctivitis or red eye of uncertain etiology Figure 2.

The diagnosis and treatment of the most common forms of conjunctivitis are also reviewed. The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. This should establish whether the condition is acute, subacute, chronic or recurrent, whether it is unilateral or bilateral, and whether it is associated with any specific environmental or work-related exposure.

Many symptoms of conjunctivitis, such as tearing, irritation, stinging and burning are nonspecific. However, certain symptoms may strongly suggest a particular diagnosis. Itching is the hallmark of allergic conjunctivitis, as well as other forms of allergic eye disease. The itching may be mild to severe. In general, a red eye in the absence of itching is not caused by ocular allergy. A history of recurrent itching or a personal or family history of hay fever, allergic rhinitis, asthma or atopic dermatitis is also suggestive of ocular allergy.

Mild itching can also be a feature of blepharitis, dry eyes and, occasionally, bacterial or viral conjunctivitis. The type of ocular discharge, such as serous watery , mucoid, mucopurulent or grossly purulent, can be helpful in determining the underlying cause of conjunctival inflammation 1 Table 2.

Adapted with permission from Jackson WB. Differentiating conjunctivitis of diverse origins. Surv Ophthalmol ;38 Suppl — A serous discharge is most commonly associated with viral or allergic ocular conditions. A mucoid stringy or ropy discharge is highly characteristic of allergy or dry eyes.

A muco-purulent or purulent discharge, often associated with morning crusting and difficulty opening the eyelids, strongly suggests a bacterial infection. The possibility of Neisseria gonorrhoeae infection should be considered when the discharge is copiously purulent.

The preceding generalizations about ocular discharges can be helpful in distinguishing between viral and simple bacterial conjunctivitis. However, in the absence of a definitive diagnosis, many physicians elect to empirically prescribe topical antibiotics. Allergic conjunctivitis is almost always secondary to environmental allergens and, therefore, usually presents with bilateral symptoms.

Often, these infections initially present in one eye, with the second eye becoming involved a few days later.

Since chronic unilateral conjunctivitis can have a number of causes, it often presents a difficult diagnostic dilemma. Therefore, patients with this condition should be referred for full ophthalmic assessment to rule out less common entities, such as keratitis, nasolacrimal duct obstruction, occult foreign body and conjunctival neoplasia Figure 3.

Sebaceous cell carcinoma that is invading the conjunctiva and the superficial cornea. The patient was initially referred for the evaluation of chronic unilateral conjunctivitis.

Pain and photophobia are not typical features of a primary conjunctival inflammatory process. If these features are present, the physician should consider more serious underlying ocular or orbital disease processes, including uveitis, keratitis, acute glaucoma and orbital cellulitis. Similarly, blurred vision that fails to clear with a blink is rarely associated with conjunctivitis. Patients with pain, photophobia or blurred vision should be referred to an ophthalmologist.

A recent upper respiratory tract infection in the patient's home, school or workplace suggests a diagnosis of infectious conjunctivitis, especially of adenoviral origin. Chlamydial or gonococcal infection may be suggested by the patient's sexual history, including a history of urethral discharge. The physician should also inquire about the patient's use of systemic and over-the-counter topical medications e.

Therefore, unless questioned directly, they generally do not volunteer information about their use of these medications. A history of collagen vascular disease or the use of diuretics or antidepressant medications should alert the physician to the possibility of dry eyes. The patient should be examined in a well-lit room. Before performing the ocular examination, the physician should search for regional lymphadenopathy and should examine the face and eyelids carefully.

Viral or chlamydial inclusion conjunctivitis typically presents with a small, tender, preauricular or submandibular lymph node. Toxic conjunctivitis secondary to topical medications can also produce a palpable preauricular node.

Palpable adenopathy is rare in acute bacterial conjunctivitis. The exception is hyperacute conjunctivitis caused by infection with Neisseria species. Other facial clues to the etiology of conjunctivitis include the presence of herpes labialis or a dermatomal vesicular eruption suggestive of shingles. Either of these findings may indicate a herpetic source of conjunctivitis. Cultures usually are not required in patients with mild conjunctivitis of suspected viral, bacterial or allergic origin.

However, specimens for bacterial cultures should be obtained in patients who have severe inflammation e. Cultures also should be obtained in patients who do not respond to treatment. Several laboratory procedures can be used to identify chlamydial infections. These include cell culture, direct fluorescent monoclonal antibody staining of smears, enzyme immuno-assays for Chlamydia organisms, DNA hybridization assays and a polymerase chain reaction test to identify chlamydial antigens.

The findings can be helpful, particularly for diagnosing allergic, chlamydial and certain atypical forms of conjunctivitis in which the clinical diagnosis is not immediately apparent. Hyperacute bacterial conjunctivitis is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management.

The infection has an abrupt onset and is characterized by a copious yellow-green purulent discharge that reaccumulates after being wiped away. Patients demonstrate marked conjunctival injection, conjunctival chemosis excessive edema , lid swelling and tender preauricular adenopathy. The most frequent causes of hyperacute purulent conjunctivitis are N. These two infections have similar clinical presentations, and they can be distinguished only in the microbiology laboratory.

Gonococcal ocular infection usually presents in neonates ophthalmia neonatorum and sexually active young adults. Affected infants typically develop bilateral discharge three to five days after birth Figure 4. Transmission of the Neisseria organism to infants occurs during vaginal delivery.

In adults, the organism is usually transmitted from the genitalia to the hands and then to the eyes. Neonatal hyperacute purulent conjunctivitis caused by Neisseria gonorrhoeae. If a gonococcal ocular infection is left untreated, rapid and severe corneal involvement is inevitable. Infected infants may also have other localized gonococcal infections, such as rhinitis or proctitis, or they may have disseminated gonococcal infection, such as arthritis, meningitis, pneumonia or sepsis.

The diagnostic work-up for a gonococcal ocular infection includes immediate Gram staining of specimens for gram-negative intra-cellular diplococci, as well as special cultures for Neisseria species. All patients should be treated with systemic antibiotics supplemented by topical ocular antibiotics and saline irrigation. Because of the increasing prevalence of penicillin-resistant N.

Over 30 percent of patients with gonococcal conjunctivitis have concurrent chlamydial venereal disease. For this reason, it is advisable to treat patients with supplemental oral antibiotics that are effective against Chlamydia species. Acute bacterial conjunctivitis typically presents with burning, irritation, tearing and, usually, a mucopurulent or purulent discharge Figure 5.

Patients with this condition often report that their eyelids are matted together on awakening. Conjunctival swelling and mild eyelid edema may be noted. The symptoms of acute bacterial conjunctivitis are far less severe, less rapid in onset, and progress at a much slower rate than those of hyperacute conjunctivitis. Acute bacterial conjunctivitis caused by Streptococcus pneumoniae.

The three most common pathogens in bacterial conjunctivitis are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Antibiotics do not kill viruses. This kind of pink eye gets better when you avoid the things that are causing the allergy. A third type of pink eye is caused by bacteria. This can be helped by an antibiotic. Antibiotics can cause problems.

Antibiotics can cause itching, stinging, burning, swelling and redness. They can cause more discharge. And they can cause allergic reactions in some people. National Center for Biotechnology Information , U. Journal List Clin Ophthalmol v. Clin Ophthalmol. Published online Dec 6. Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC.

Abstract Clinical question What is the best treatment for bacterial conjunctivitis? Results Topical antibiotics expedite recovery from bacterial conjunctivitis. Implementation Recognition of key distinguishing features of bacterial conjunctivitis Pitfalls that can be recognized in the history and physical examination Choice of antibiotic When to refer for specialist treatment. Keywords: bacterial conjunctivitis, topical antibiotics.

Bacterial conjunctivitis Definition: Bacterial conjunctivitis is inflammation of the conjunctiva as a result of bacterial infection. Outcomes: From the patient perspective, the main outcomes are: Speed of symptomatic resolution Convenience of treatment Avoidance of complications. The evidence Do any interventions make a difference to the resolution of bacterial conjunctivitis?

Systematic reviews: 2 Meta-analyses: 1 Randomized controlled trials: Open in a separate window. Table 1 Randomized controlled trials comparing antibiotics with placebo. Everitt et al 5 Two groups received chloramphenicol One group received placebo Symptomatic relief Antibiotic decreased the duration of symptoms. Hwang et al 6 One group received levofloxacin One group received placebo Clinical resolution and bacterial eradication Higher rate of microbial and clinical cure with antibiotic.

Lichtenstein and Rinehart 9 One group received levofloxacin One group received ofloxacin One group received placebo Clinical resolution and bacterial eradication Higher rate of microbial and clinical cure with antibiotics. Miller et al 10 One group received norfloxacin One group received placebo Bacterial eradication and clinical resolution Higher rate of microbial and clinical cure with antibiotic.

Which antibiotics are best for accelerating resolution of bacterial conjunctivitis? Systematic reviews: 1 Meta-analyses: 0 Randomized controlled trials: Table 2 Topical antibiotics used to treat bacterial conjunctivitis. Table 3 Randomized controlled trials comparing different topical antibiotics. Which treatment regimen works best for bacterial conjunctivitis?

Systematic reviews: 0 Meta-analyses: 0 Randomized controlled trials: 4. Table 4 Randomized controlled trials comparing different regimens of treatment. Conclusions Bacterial conjunctivitis often resolves on its own, but the current evidence suggests that topical antibiotics help accelerate recovery from this self-limiting disease. The practice Potential pitfalls Contact lens wearers are predisposed to Gram-negative infections, carrying a higher risk of complications, such as bacterial keratitis.

If there is an associated keratitis or anterior uveitis, referral to a specialist may be recommended Beware of combination topical antibiotic agents that contain steroids. Management Bacterial conjunctivitis can be managed by nonspecialists. Footnotes Disclosure The authors report no conflicts of interest in this work.

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