TOC | ID
Conjunctivitis Red eye
The term conjunctivitis refers to an inflammation of the conjunctiva resulting from a variety of causes, including allergies and bacterial, viral, and chlamydial infections.
* Cultures are useful if not successfully treated with antibiotic medications; initial culture is usually not necessary.
Common Red Eye emergencies can be rapidly diagnosed by asking 3 important questions:
|Treatment for Non-emergent Red Eye
Patients with allergic conjunctivitis present with itching of the eyes, accompanied by tearing and a burning sensation. The reaction is usually bilateral, although unilateral conjunctivitis may occur in a patient who has had direct hand-to-eye contact with an allergen such as dog or cat dander.
The periocular tissues are usually swollen and reddened. The conjunctiva is injected, with mild to moderate chemosis, and there is a ropy mucous discharge in the tear film.
Differential Diagnosis of Allergic Conjunctivitis
Treatment of Allergic Conjunctivitis
Drug treatment for allergic conjunctivitis typically begins with a topical over-the-counter antihistamine-decongestant combination such as antazoline-naphazoline (Vasocon-A) or pheniramine-naphazoline (Naphcon-A). The next line of therapy would include a selective H1 receptor antihistamine, a category that includes ketotifen (Zaditor), epinastine (Elestat), levocabastine (Livostin), azelastine (Optivar), and olopatadine (Patanol). Ketotifen, epinastine, and olopatadine also have mast cell-stabilizing properties.
Warm compresses if infective conjunctivitis
Cold compresses in irritative or allergic conjunctivitis
ACUTE GENERAL Rx
Antibiotic drops (e.g., levofloxacin, ofloxin, ciprofloxacin
ophthalmic solution one or two drops q24h)
Topical anesthetics: Ketorolac (Acular) 1 gtt qid
Caution: be careful with corticosteroid (Dexamethasone or Prednisolone) treatment and avoid unless sure of diagnosis; corticosteroids can exacerbate infections
Depends on the cause
If allergic, nonsteroidals such as Voltaren (diclofenac) ophthalmic solution, mast cell stabilizers such as Elestat (epinastine), Alocril (nedocromil), Patanol (olopatadine), Zaditor (ketotifen) are useful
If infections, antibiotic drops (see Acute General Rx)
Dry eyes need artificial tears, ristasis, lacrameal duct plugs when indicated
Red eyes are not just conjunctivitis when there is significant pain or loss of sight. However, it is usually safe to treat pain-free eyes and the normal seeing red eye with lid hygene and topical treatment.
Beware of patients wearing soft contact lenses and of babies and the elderly.
Do not use steroids indiscriminately; use only when the diagnosis is certain.
REF: Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 8th ed., 2006
To ophthalmologist if symptoms refractory to initial treatment