At a Glance: Bacterial conjunctivitis vs acute anterioruveitis

Bacterial conjunctivitis

Presentation

  • Conjunctivitis is inflammation of the conjunctiva caused by bacteria, virus or allergy or associated with foreign body.
  • Bacteria involved are commonly Staphylococcus, Streptococcus pneumoniae or Haemophilus influenza.
  • More often Gram-negative bacteria in patients with contact lens.
  • Eye feels gritty (allergic conjunctivitis is itchy).
  • Watering of the eye - discharge may be yellow/white and mucopurulent.

Management

  • Check to exclude foreign body.
  • May resolve without treatment.
  • Avoid spread to contacts.
  • Swab from discharge for culture and sensitivities.
  • Topical chloramphenicol or gentamicin eye drops.
  • Azithromycin twice daily for three days may be helpful.
  • Gonococcal and chlamydia conjunctivitis requires topical and systemic antibiotics. This is likely to be sexually transmitted and so a full check of patient and contacts would be required.

Acute anterior uveitis (iritis)

Presentation

  • Painful red eye - usually unilateral.
  • Photophobia and watering of the eye - not mucopurulent.
  • Usually occurs after the age of 20. Usually idiopathic and may have recurrent episodes.
  • May be associated with HLA-B27, herpes zoster, ankylosing spondylitis, inflammatory bowel disease, sarcoidosis, reactive arthritis or reaction to drugs.
  • Irregular, poorly reactive constricted pupil as the condition develops.

Management

  • Patients should be referred urgently to the ophthalmic unit for slit lamp examination, fundoscopy, measurement of intraocular pressures and check of visual acuity.
  • Specialist advice regarding mydriatics and cycloplegics such as cyclopentolate or homatropine eye drops.
  • Prednisolone eye drops.

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