DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
Conjunctivitis is a potentially blinding condition with associated systemic manifestations
RECOGNITION AND ASSESSMENT
- Conjunctival redness
- Swelling of conjunctiva and eyelids
- Purulent or mucopurulent discharge
- Vesicles on lids or adjacent skin (herpes simplex)
Differential diagnosis
- Sticky eye with blocked tear duct in which there is no inflammation of conjunctiva
- Congenital glaucoma in which there is corneal opacity
- Swelling of conjunctiva and eyelids as part of preseptal or orbital cellulitis
AETIOLOGY
Bacterial
- Staphylococcus aureus
- Haemophilus influenzae
- Streptococcus pneumoniae
- Serratia spp, E. coli, Pseudomonas spp
- Neisseria gonorrhoeae – typical onset aged 0–5 days: mild inflammation with sero-sanguineous discharge to thick, purulent discharge with tense oedema of eyelids
- Chlamydia trachomatis – typical onset aged 5–14 days: mild-to-severe swelling with purulent discharge (may be blood-stained)
Viral
- Herpes simplex virus (HSV)
MANAGEMENT
- 4–6 hrly eye toilet using sodium chloride 0.9%
- cooled, boiled tap water acceptable for home use
Conjunctivitis (see signs above)
- Swab all for:
- Gram stain and bacterial culture and sensitivities
- if other suspicions of HSV (e.g. vesicles etc.), swab for HSV PCR
- use dry swab/moistened with viral transport media
- place in dry tube/pot
- swab using dry swab/moistened with viral transport media, and place in dry tube/pot (check for Chlamydia trachomatis and Neisseria gonorrhoeae PCR)
- Treat both eyes with:
- frequent eye toilet as necessary
- chloramphenicol 0.5% eye drops
- fusidic acid 1% eye drops for Staphylococcus
- Presentation ≤24 hr of birth suggests gonococcal infection – inform consultant paediatrician
- If herpes suspected, begin treatment with aciclovir IV and aciclovir eye ointment while awaiting results
SUBSEQUENT MANAGEMENT
In severe non-resolving cases
- Take throat and eye swabs for viral PCR
- If herpes suspected, look for other signs of herpetic infection
- Treat suspected herpes with aciclovir IV and topical for 14 days
- Refer to ophthalmology
Neisseria gonorrhoeae suspected
- Request urgent Gram stain and culture
- Assess baby for sepsis
- Swab for PCR
Neisseria gonorrhoeae confirmed
- Give single dose ceftriaxone 25–50 mg/kg IV (maximum 250 mg) or if hyperbilirubinaemia or premature give cefotaxime 100 mg/kg IV
- Refer to ophthalmology
Chlamydia
- If result positive treat:
- azithromycin 20 mg/kg IV single dose
- and azithromycin eye drops twice daily for 3 days
- If maternal chlamydia treated successfully in pregnancy, baby does not require prophylactic treatment
- if unsure, swab baby’s conjunctiva using nucleic acid amplification test (NAAT) swab
- if high risk, send bacterial swab for gonococcus and HIV antibody, HBsAg and HCV antibody from mother or baby
Gonococcal or chlamydia infection detected
- Refer mother and partner to genitourinary medicine for immediate treatment