Conjunctivitis
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
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Conjunctivitis, bacterial (non-gonococcal)
Conjunctivitis, bacterial (gonococcal)
H10.9
DESCRIPTION
- Inflammation of the conjunctiva, usually due to allergy or infection (viral or bacterial).
- Conjunctivitis is usually bilateral. Other causes of a red eye are often unilateral.
- The condition is self-limiting and usually resolves within 14 days.
GENERAL MEASURES
- If it is due to an infection, counsel on the importance of:
- frequent hand washing,
- using separate linen, towels and washcloths, and
- avoiding direct contact with infected material or individuals. - Contact lenses should not be worn if conjunctivitis is present or during a course of topical therapy. Soft lenses should not be worn within 24 hours of instilling eye drops containing the preservative benzalkonium chloride.
CONJUNCTIVITIS, VIRAL
B30.1+ (H13.1*)
DESCRIPTION
- Viral conjunctivitis is the commonest cause of infective conjunctivitis. It may be unilateral but often progresses to bilateral.
- Adenovirus is the commonest viral conjunctivitis, however other viral causes of conjunctivitis present in the same way.
Clinical features:
- Viral conjunctivitis may be associated with an upper respiratory tract infection.
- A burning, sandy, or gritty feeling in the eyes.
- Morning crusting followed by watery discharge.
- Preauricular lymphadenopathy may be present.
- The cornea, iris, and pupil are completely normal with normal visual acuity.
The condition is self-limiting but eye irritation and discharge may get worse for the first week depending on the specific virus. Duration varies from 3-5 days to 2-3 weeks before resolution.
MEDICINE TREATMENT
- Sodium chloride 0.9%, eye washes or irrigation.
If sodium chloride 0.9% is not available use cooled boiled water/sterile water.
- Oxymetazoline 0.025%, ophthalmic drops, instil 1 drop 6 hourly for a maximum of 7 days to reduce redness of eyes.
CONJUNCTIVITIS, ALLERGIC
See Primary Health Care Standard Treatment Guidelines and Essential Medicine List: Conjunctivitis, allergic.
CONJUNCTIVITIS, BACTERIAL (NON-GONOCOCCAL)
H10.0
DESCRIPTION
Clinical features:
- It may be either unilateral or bilateral.
- There is matting of lashes in the morning with the eyelids stuck shut.
- There is a mucopurulent discharge throughout the day.
- The eyelids may be swollen.
MEDICINE TREATMENT
- Immediate irrigation of the eyes with sodium chloride 0.9%.
During the day:
- Chloramphenicol 1%, ophthalmic ointment 6 hourly for 7 days.
LoE: IVbi
OR
- Fluoroquinolone ophthalmic drops as second-line treatment, (i.e. poor response to chloramphenicol or contra-indication/drug interactions with chloramphenicol) e.g.:
- Ciprofloxacin 0.3%, ophthalmic drops, instil 1 drop 2 hourly for 2 days.
- Then reduce frequency to 1 drop 4 hourly during waking hours, for 5 days.
- Ciprofloxacin 0.3%, ophthalmic drops, instil 1 drop 2 hourly for 2 days.
LoE: IIbii
REFERRAL
- No response to treatment.
CONJUNCTIVITIS, BACTERIAL (GONOCOCCAL)
H10.0
Hyperacute bacterial conjunctivitis involves rapid onset and progression of conjunctivitis and is often caused by N.gonorrhoeae. Gonococcal conjunctivitis requires immediate referral to an ophthalmologist to prevent corneal involvement and potential perforation.
Clinical features:
- Hyperpurulent discharge
- Diminished visual acuity
- Eye tenderness
- Swollen lymph nodes
For conjunctivitis of the newborn, See Primary Health Care Standard Treatment Guidelines and Essential Medicine List: Conjunctivitis of the newborn
MEDICINE TREATMENT
- Ceftriaxone, IM, 250 mg as a single dose.
- For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without epinephrine (adrenaline)
AND
- Azithromycin, oral, 1 g as a single dose.
For persistent infection, refer to: Male urethral syndrome or Vaginal discharge syndrome.
REFERRAL
- Refer all cases to an ophthalmologist immediately.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_30 September 2024
Chapter 18 Eye Disorders_18.1 Conjunctivitis