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Conjunctiva

Allergic conjunctivitis

Often self limiting

  • Management:
    • Mast cell stabiliser eg drops of sodium cromoglycate, lodoxamide, oral antihistamine.
    • Treat blepharitis, dry eye, avoid make up
    • If multiple previous medications worth stopping all treatment and see if symptoms resolve
    • If patient is on brimonidine for glaucoma this maybe delayed hypersensitivity response -  stop brimonidine and write to consultant in charge
  • When to refer: -
    • Refer if severe symptoms persist warranting topical steroid or corneal involvement
    • Urgent referral if very red eye, loss of vision

 

Conjunctivitis

Maybe bacterial or viral. Often self limiting

If viral, often preceded by URTI and has pre-auricular lymphadenopathy. Usually self resolving.

  • Management
    • Topical antibiotics only used if not resolving after 3 days. eg one hourly Chloramphenicol drops, fucithalmic drops or, if resistant, ofloxacillin drops, reducing over next week
    • Can give prophylactic antibiotics
    • If Chlamydial usually sexually active and resistant to above drugs. Swab in surgery and refer to GUM for treatment with azithromycin, full STI check and partner management. If severe GUM will refer on to ophthalmology as well.
  • When to refer: - 
    • Refer routine if no resolution after 2 courses of antibiotics.
    • Eye casualty if orbital cellulitis, obvious corneal involvement, persistent conjunctivitis in presence of trabeculectomy (?blebitis), within one week post-intraocular surgery (?enophthalmitis), loss of vision.
    • Urgent referral for neonates  

 

Herpes Zoster Ophthalmicus

  • Management
    • If mild conjunctivitis and no severe eye symptoms manage with systemic acyclovir and/or topical Chloramphenicol.
  • When to refer
    • Refer eye casualty if mod/severe conjunctivitis risk of inflammatory ocular hypertension, corneal involvement, visual loss or severe symptoms.