Conjunctivitis, Bacterial (Excluding Conjunctivitis of the Newborn)
Conjunctivitis
H10.0
DESCRIPTION
An inflammatory purulent condition of the conjunctivae caused by bacterial infection and characterised by:
- Sore, gritty or scratchy eyes and swollen lids
- Mucopurulent discharge from one or both eyes
- Redness especially of conjunctival angles (fornices)
GENERAL MEASURES
- Educate patient on personal hygiene to avoid spread e.g. do not use the same face-cloth or towels as others
- Do not use contaminated cosmetics
- Practise good contact lens hygiene
- Avoid chronic use of topical medications
- Educate patient on correct application of ophthalmic ointment
- Advise patient:
- To wash hands thoroughly before and after applying ophthalmic ointment
- Not to share ophthalmic ointments or drops
- Not to rub eyes
- Never to use urine or milk to wash the eyes
MEDICINE TREATMENT
- Chloramphenicol 1%, ophthalmic ointment, applied 6 hourly for 7 days
Pain:
Children
- Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: dosing table
Adults
- Paracetamol, oral, 500 mg -1 g, 4–6 hourly when required (to a maximum of 4 g in 24 hours)
- Maximum dose: 15 mg/kg/dose
Gonococcal conjunctivitis:
Hyperacute bacterial conjunctivitis involves rapid onset and progression of conjunctivitis with a hyperpurulent discharge, and is often caused by N.gonorrhoeae. Gonococcal conjunctivitis requires immediate treatment and referral to an ophthalmologist to prevent corneal involvement and potential perforation.
Neonates
Refer to Conjunctivitis of the newborn
Children 1 month to 11 years:
- Ceftriaxone, IM,
- < 45 kg: 125 mg, IM, as a single dose
- ≥ 45 kg: 250 mg, IM, as a single dose
Adults and children 12 years and older
- 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.
Refer to Section 12.3 Sexually transmitted infections for further detail.
REFERRAL
- No response after 5 days
- All cases of unilateral conjunctivitis, as this may be caused by a foreign body
- Loss of vision
- Irregularity of pupil
- Haziness of the cornea
- Persistent painful eye
- Suspected or confirmed gonococcal conjunctivitis.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_30 September 2024
Chapter 18: Eye Conditions_18.1 Conjunctivitis_18.1.2 Conjunctivitis, Bacterial (Excluding Conjunctivitis of the Newborn)