3.5 Conjunctivitis, Bacterial

Date of last review: Due to be updated

Differential diagnosis

  • Epidemic keratoconjunctivitis (e.g. adenovirus)
  • Herpes simplex or Herpes zoster
  • Chlamydial infection
  • Allergy
  • Angle closure glaucoma
  • Infective keratitis
  • Anterior uveitis

Possible management by Optometrist

  • Beware corneal involvement in contact lens wearers
  • Treatment with topical antibiotic for one week may improve short-term outcome and render patient less infectious to others
    • Ask if allergic to Chloramphenicol
    • If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
    • If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for a week
  • Bathe/clean the eyelids with proprietary sterile wipes, lint or cotton wool dipped in sterile saline or boiled (cooled) water to remove crusting

Advice

  • Advise patient that condition is contagious (do not share towels, etc.)
  • Contact lenses should not be worn during the treatment period
  • Advise patient to return/seek further help if symptoms persist beyond 7 days
    • If no improvement, consider allergic reaction to medication, especially if there are new areas of periorbital redness or excoriation
    • If allergic to Chloramphenicol, explain symptoms will get better on stopping Chloramphenicol and to avoid using Chloramphenicol in the future
    • Refer to ophthalmology If no evidence of allergic reaction

Management Category

  • Management to resolution
  • Refer if:
    • Condition fails to resolve
    • There is corneal involvement

Possible management by Ophthalmologist

  • Conjunctival swabs taken for microscopy and culture and/or PCR analysis
  • Treatment with other antibiotics, based on culture results