Bacterial conjunctivitis

Bacterial conjunctivitis is a very common and usually self-limited inflammatory disease of the conjunctiva that typically affects children.

Bacterial conjunctivitis is caused by numerous bacteria. Symptoms include hyperemia, lacrimation, irritation, and discharge. Diagnosis is clinical. Treatment consists of topical antibiotics, augmented by systemic antibiotics in more severe cases.

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Causes of bacterial conjunctivitis

Bacterial conjunctivitis is usually acquired through direct contact with infected mucus.

Bacterial conjunctivitis is usually caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus sp. or less commonly Chlamydia trachomatis, Neisseria gonorrhoeae causes gonococcal conjunctivitis, which usually results from sexual contact with a person with a urogenital infection.

Ophthalmia neonatorum is a conjunctivitis that occurs in 20-40% of newborns who pass through an infected birth canal. The condition may be associated with maternal gonococcal or chlamydial infection.

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Symptoms of bacterial conjunctivitis

Bacterial conjunctivitis has the following symptoms: sharp redness of the conjunctiva of the eye, a feeling of sand, burning and discharge. When waking from sleep, the eyelids often stick together and are difficult to open as a result of exudate that accumulates during the night. Usually, both eyes are involved in the inflammatory process, but not always simultaneously.

The eyelids are crusted and swollen. The discharge is initially usually watery, resembling viral conjunctivitis, but within about 1 day it becomes mucopurulent. Mucus in the form of threads can be found in the lower fornix. The most pronounced hyperemia is in the fornix and less so at the limbus. The tarsal conjunctiva is velvety, red, with moderate papillary changes. Superficial epitheliopathy and epithelial erosions are often encountered, which are often harmless.

The conjunctiva of the eyelids and the eyeball is intensely hyperemic and edematous. Petechial subconjunctival hemorrhages, chemosis, eyelid edema, and enlarged preauricular lymph nodes are usually absent.

In adults with gonococcal conjunctivitis, symptoms develop 12 to 48 hours after exposure. There is marked eyelid edema, chemosis, and purulent exudate. Rare complications include corneal ulceration, abscess, perforation, panophthalmitis, and blindness.

Ophthalmia neonatorum due to gonococcal infection manifests itself 2-5 days after birth. Symptoms of ophthalmia neonatorum due to chlamydial infection manifest themselves 5-14 days after birth. Symptoms are bilateral, there is pronounced papillary conjunctivitis with eyelid edema, chemosis and mucopurulent discharge.

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Diagnosis of bacterial conjunctivitis

Smears and bacterial cultures should be obtained in cases of severe symptoms, in immunocompromised patients, in cases of unsuccessful primary therapy, and in the presence of risk factors (e.g., after corneal transplantation, in exophthalmos due to Graves' disease). Smears and scrapings from the conjunctiva should be examined microscopically and stained with Gram stain to identify bacteria and with Giemsa stain to identify the characteristic bodies embedded in the basophilic cytoplasm of epithelial cells in chlamydial conjunctivitis.

Treatment of bacterial conjunctivitis

Bacterial conjunctivitis is highly contagious, so all standard measures should be taken to prevent the spread of infection.

If neither gonococcal nor chlamydial infection is suspected, most clinicians treat conjunctivitis for 7 to 10 days with 0.5% moxifloxacin drops 3 times daily, or another fluoroquinolone, or trimethoprim/polymyxin B 4 times daily. Low response after 2 to 3 days suggests that the disease is viral or allergic in origin, or that the bacteria are resistant to the prescribed treatment. Culture and susceptibility testing to antibiotics guide subsequent treatment.

Gonococcal conjunctivitis in adults requires a single dose of ceftriaxone 1 g intramuscularly or ciprofloxacin 500 mg twice daily for 5 days. In addition to systemic treatment, bacitracin 500 units/g or 0.3% gentamicin ophthalmic ointment applied to the affected eye may be used. Sexual partners should also be treated. Because patients with gonorrhea often have chlamydial urogenital infection, patients should also receive a single dose of 1 g azithromycin or doxacycline 100 mg twice daily for 7 days.

Ophthalmia neonatorum is prevented by using silver nitrate or erythromycin drops at birth. Infections that are not cured this way require systemic therapy. For gonococcal infection, ceftriaxone is given 25-50 mg/kg intravenously or intramuscularly once a day for 7 days. Chlamydial infection is treated with erythromycin 12.5 mg/kg 4 times a day for 14 days. The parents should also be treated.

Even without treatment, simple bacterial conjunctivitis usually resolves within 10-14 days, so laboratory tests are not usually performed. Before starting treatment for bacterial conjunctivitis, it is important to clean the eyelids and remove discharge. Until the discharge stops, broad-spectrum antibacterial agents should be used throughout the day in the form of drops and before bedtime in the form of an ointment.

Antibiotics in drops

• Fusidic acid (fucithalmic) is a viscous suspension used for staphylococcal infections, but it is not effective against most gram-negative microorganisms. Initial treatment is 3 times a day for 48 hours, then 2 times a day;
• Chloramphenicol has a broad spectrum of action and is initially prescribed every 1-2 hours;
• other antibacterial drugs: ciprofloxacin, ofloxacin, lomefloxacin, gentamicin, neomycin, framycin, tobromycin, neosporin (polymyxin B + neomycin + gramicidin) and polytrim (polymyxin + trimethoprim).

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Antibiotics in ointment form

Antibiotics in the form of ointments provide a higher concentration over a longer period than drops, but their use during the day should be limited, as they cause a latent course of the disease. Ointments are best used at night to ensure a good concentration of the antibacterial drug throughout sleep.

• Antibiotics in ointment form: chloramphenicol, gentamicin, tetracycline, framycetin, polyfax (polymyxin B + bacitracin) and polytrim

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