Eye Infection, Complicated (Severe Eye Infection)
Description General and supportive measures Medicine treatment Referral ICD-10 code: H44.0 DESCRIPTION Intensely painful eye infection characterised by a red eye with or without a discharge (excluding simple or non-painful conjunctivitis). Assess clinically for: Herpes conjunctivitis, indicated by vesicles on skin next to the eye. Loss of vision. Irregularity of the pupil. Haziness of the cornea.
Description
General and supportive measures
Medicine treatment
Referral
ICD-10 code: H44.0
DESCRIPTION
Intensely painful eye infection characterised by a red eye with or without a discharge (excluding simple or non-painful conjunctivitis).
Assess clinically for:
- Herpes conjunctivitis, indicated by vesicles on skin next to the eye.
- Loss of vision.
- Irregularity of the pupil.
- Haziness of the cornea.
Investigations
Swab the eye for microbiological culture.
GENERAL AND SUPPORTIVE MEASURES
Patient education on personal hygiene to avoid spread.
Educate patient on correct application of ophthalmic drops.
Advise patient:
- to wash hands thoroughly before applying ophthalmic ointment,
- not to share ophthalmic ointments or drops,
- not to rub eyes, and
- never to use urine or milk to wash the eyes.
MEDICINE TREATMENT
If herpes infection is suspected, treat as outlined in: Herpes keratitis and conjunctivitis. If a bacterial cause is demonstrated or suspected:
During the day:
- Tobramycin, ophthalmic drops, instil 1 drop 4 - 6 hourly.
OR
- Chloramphenicol, 0.5% ophthalmic drops, instil 1 drop 4 - 6 hourly.
AND
Apply at night:
- Tobramycin, 0.3% ophthalmic ointment.
OR
- Chloramphenicol, 1% ophthalmic ointment.
REFERRAL
To an ophthalmologist within 24 hours if associated with any of the following acute signs:
- Reduced vision.
- A cloudy cornea.
- A corneal opacity or a staining corneal ulcer.
- Pus and blood level in the anterior chamber (hypopion and hyphaema).
- Cloudiness in the anterior chamber (poor view of iris details).
- An irregular or dilated (including partially dilated) pupil.
- A cloudy or poor view of the retina.
- A poor or greyish red-reflex.
- Proptosis.
- Restricted ocular movements.
- Severe ocular pain.
Non-urgent referral:
- A unilateral red eye for more than one day.
- No improvement after 5 days of treatment.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.1 Eye Infection, Complicated (Severe Eye Infection)