- Published on
Ophthalmology – Acute Bacterial Conjunctivitis
Acute bacterial conjunctivitis is a common inflammation of the conjunctiva, the mucous membrane lining the inner eyelids and covering the sclera. It affects individuals of all ages and is particularly frequent in children, where bacteria account for the majority of infectious conjunctivitis cases. The condition is highly contagious and represents a significant portion of primary care and ophthalmology visits.
Patients typically present with a red eye accompanied by purulent (yellow-green) discharge, which often leads to eyelid crusting or “glued eyes” upon waking. Symptoms frequently involve both eyes, though one eye may be affected first. Other features include irritation, tearing, and mild discomfort. Unlike viral conjunctivitis, watery discharge is less prominent, and severe pain or vision loss should prompt evaluation for alternative diagnoses. In hyperacute cases—most notably caused by Neisseria gonorrhoeae—patients may develop copious discharge and rapid progression, posing a risk for corneal damage.
The most common causative organisms include Staphylococcus aureus (more common in adults), Haemophilus influenzae and Streptococcus pneumoniae (common in children), and Moraxella catarrhalis. Chronic cases may be caused by Chlamydia, while hyperacute cases are associated with gonococcal infection. Risk factors include close contact with infected individuals, sinusitis, and immunocompromised states.
Diagnosis is usually clinical, though it can be challenging to distinguish from viral conjunctivitis based on symptoms alone. On examination, findings may include conjunctival injection, papillary reaction, and purulent discharge. Preauricular lymphadenopathy is uncommon in bacterial cases. Laboratory testing (culture or Gram stain) is reserved for severe, recurrent, or nonresponsive cases, or when gonococcal or chlamydial infection is suspected.
Treatment typically involves topical antibiotics, which shorten the duration of symptoms and reduce transmission. First-line options include trimethoprim-polymyxin B or fluoroquinolone eye drops for about 7 days. Hyperacute gonococcal conjunctivitis requires systemic antibiotics such as intramuscular ceftriaxone, often combined with topical therapy and close follow-up due to the risk of corneal ulceration and perforation. Supportive care includes artificial tears, good hygiene, and avoidance of sharing personal items.
The prognosis is excellent, as most cases are self-limiting, even without treatment. However, antibiotics speed recovery and reduce spread. Patients should be advised that they remain contagious for 24–48 hours after starting antibiotics. Follow-up is recommended if symptoms worsen, vision decreases, or there is no improvement within a week. Complications are rare but may include keratitis in severe or untreated cases.
Acute bacterial conjunctivitis is a common inflammation of the conjunctiva, the mucous membrane lining the inner eyelids and covering the sclera. It affects individuals of all ages and is particularly frequent in children, where bacteria account for the majority of infectious conjunctivitis cases. The condition is highly contagious and represents a significant portion of primary care and ophthalmology visits.
Patients typically present with a red eye accompanied by purulent (yellow-green) discharge, which often leads to eyelid crusting or “glued eyes” upon waking. Symptoms frequently involve both eyes, though one eye may be affected first. Other features include irritation, tearing, and mild discomfort. Unlike viral conjunctivitis, watery discharge is less prominent, and severe pain or vision loss should prompt evaluation for alternative diagnoses. In hyperacute cases—most notably caused by Neisseria gonorrhoeae—patients may develop copious discharge and rapid progression, posing a risk for corneal damage.
The most common causative organisms include Staphylococcus aureus (more common in adults), Haemophilus influenzae and Streptococcus pneumoniae (common in children), and Moraxella catarrhalis. Chronic cases may be caused by Chlamydia, while hyperacute cases are associated with gonococcal infection. Risk factors include close contact with infected individuals, sinusitis, and immunocompromised states.
Diagnosis is usually clinical, though it can be challenging to distinguish from viral conjunctivitis based on symptoms alone. On examination, findings may include conjunctival injection, papillary reaction, and purulent discharge. Preauricular lymphadenopathy is uncommon in bacterial cases. Laboratory testing (culture or Gram stain) is reserved for severe, recurrent, or nonresponsive cases, or when gonococcal or chlamydial infection is suspected.
Treatment typically involves topical antibiotics, which shorten the duration of symptoms and reduce transmission. First-line options include trimethoprim-polymyxin B or fluoroquinolone eye drops for about 7 days. Hyperacute gonococcal conjunctivitis requires systemic antibiotics such as intramuscular ceftriaxone, often combined with topical therapy and close follow-up due to the risk of corneal ulceration and perforation. Supportive care includes artificial tears, good hygiene, and avoidance of sharing personal items.
The prognosis is excellent, as most cases are self-limiting, even without treatment. However, antibiotics speed recovery and reduce spread. Patients should be advised that they remain contagious for 24–48 hours after starting antibiotics. Follow-up is recommended if symptoms worsen, vision decreases, or there is no improvement within a week. Complications are rare but may include keratitis in severe or untreated cases.
0 Comments
