Treating Acute Infective Conjunctivitis - Cheshire Med

Toward A Unified Approach to Treating Acute Infective Conjunctivitis Dale Pollack, MD

Department of Ophthalmology DH-K/CMC

Acute Infective Conjunctivitis is : ? A benign, self limited disease ? Symptoms are red, painless, eye(s) with watery or mucopurulent discharge, crusty lashes, and eyes matted shut in morning. Severe itching is more likely allergy. ? 60-90% are of viral etiology, usually adenovirus. ? Others are caused by bacteria. ? Bacterial etiology is more common in young children. ? Level of contagiousness is similar to the common cold.

The Natural History without treatment, whether viral or bacterial, is : ? 50% resolve in 5 days ? 70% resolve in 7 days ? 90% resolve in 9 days

Can we do a better job of differentiating viral vs. bacterial? ? DISCHARGE. Bacterial discharge tends to be predominantly muco purulent and copious. Viral discharge is predominantly watery. ? ASSOCIATED SIGNS. Viral cases often have URI symptoms, exposure to others who have been sick, and pre-auricular lymphadenopathy. ? AGE. Bacterial more common in young children.

Role of antibiotics. ? In bacterial cases, treatment with topical antibiotic improves symptoms sooner and complete resolution occurs 1-2 days sooner than without treatment. ? If symptoms are consistent with bacterial etiology, use least toxic, lowest dose for shortest interval, such as Polytrim one drop 4x/day for 5-7days. ? Antibiotics are not useful in viral cases.

Other recommendations. ? Frequent use of artificial tears ? Warm water to clean lashes ? Handwashing

CDC, NH-Dept Health and Human Services AND LOCAL SCHOOL POLICIES ? Antibiotic is not required for return to daycare, school or work. ? Children in daycare with PURULENT conjunctivits should be excluded until evaluated by health provider to rule out other systemic illness.

CONCLUSION

? Acute Infective Conjunctivitis is a benign, self limited condition most frequently caused by adenovirus in older children and adults.

? If antibiotic is prescribed, consider using the lowest dose, least toxic drug for short duration.

? Given the natural history, expect complete resolution in 90% of cases by 9 days. ? CDC, state and local school policies do not require exclusion or antibiotic usage

for this condition.

November 2010 Revised January 2012

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