Doctors Revision

Ophthalmology (Eye Conditions)

Conjunctivitis

Inflammation of the conjunctiva, the membrane lining the eyelid and covering the white part of the eyeball. Can be caused by infection, allergy, or irritation.

Also known as: Red Eye, Pink Eye

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Referral and warning signs

When to refer

Refer to Eye Specialist/Hospital if: Severe pain, Reduced visual acuity, Photophobia, Corneal opacity or staining, Suspected gonococcal conjunctivitis, No improvement after several days of treatment, Recurrent episodes, Suspicion of keratitis, uveitis, or glaucoma.

Red flags

  • Severe eye pain.
  • Decreased vision.
  • Photophobia (sensitivity to light).
  • Corneal opacity / haze / ulceration.
  • Pupil abnormalities (irregular, small/fixed).
  • Ciliary flush (redness concentrated around the cornea).
  • Marked purulent discharge (suggests gonococcal).
  • History of trauma or contact lens wear with red eye.

Signs and symptoms

  • Redness (conjunctival injection - usually diffuse, worse peripherally).
  • Discharge: Watery (viral, allergic, irritant) OR Purulent/Mucopurulent (bacterial).
  • Itching (prominent in allergic).
  • Grittiness / Foreign body sensation.
  • Eyelid swelling.
  • Crusting of eyelids upon waking (bacterial).
  • Usually bilateral, but may start in one eye.
  • Key differentiating features: Cornea is CLEAR, Visual acuity is NORMAL.

Risk factors

  • Exposure to infected individuals (viral/bacterial).
  • Allergens (pollen, dust mites, animal dander).
  • Irritants (smoke, chemicals, chlorine).
  • Poor hygiene.
  • Contact lens wear.

Diagnosis

Clinical assessment

Diagnosis based on characteristic symptoms (redness, discharge, irritation) AND confirmation of clear cornea and normal visual acuity. Differentiate type based on discharge (watery vs purulent) and presence of itching.

Investigations

  • Usually clinical diagnosis.
  • Pus swab for Gram stain, Culture & Sensitivity (if severe, chronic, neonatal, or unresponsive to treatment).

Diagnostic criteria

Conjunctival inflammation with normal vision and clear cornea.

Differential diagnosis

  • Keratitis / Corneal Ulcer (Pain, photophobia, reduced VA, corneal opacity/staining).
  • Acute Angle-Closure Glaucoma (Severe pain, nausea, halos, fixed mid-dilated pupil, hazy cornea, high IOP).
  • Uveitis (Anterior) (Pain, photophobia, ciliary flush, small/irregular pupil, reduced VA).
  • Subconjunctival haemorrhage (Blood under conjunctiva, no discharge/pain).
  • Episcleritis/Scleritis (Localized redness, deeper pain in scleritis).

Management

Non-pharmacological management

  • All types: Advise good hygiene (hand washing, avoid sharing towels). Avoid rubbing eyes.
  • Allergic: Cold compresses, avoid known allergens.
  • Irritant: Remove irritant, copious irrigation if chemical exposure.

Pharmacological treatment

  • Infective Conjunctivitis (Presumed Bacterial): (LOC: HC2)
  • - Antibiotic Eye Drops: Chloramphenicol OR Gentamicin. Apply 1 drop Q2-3H initially (for 2 days), then reduce to QID for 5-7 days total.
  • - OR Antibiotic Eye Ointment: Tetracycline 1% applied BID-QID.
  • - (Note: Specific treatment for Gonococcal conjunctivitis needed - see STI section 3.2.9).
  • Viral Conjunctivitis (e.g., Adenoviral):
  • - Usually self-limiting (7-14 days).
  • - Artificial tears for comfort.
  • - Cold compresses.
  • - Antibiotics NOT effective, but sometimes given to prevent secondary infection.
  • - Advise strict hygiene (highly contagious).
  • Allergic Conjunctivitis: (LOC: HC2)
  • - Topical Antihistamine / Mast cell stabilizer eye drops (e.g., Olopatadine, Ketotifen) - if available.
  • - Short course Topical Steroid eye drops (e.g., Betamethasone, Hydrocortisone) - USE WITH CAUTION & FOR SHORT DURATION ONLY, ensure diagnosis is correct (can worsen infections, esp. herpes). Apply Q1-2H initially, then taper. (UCG suggests HC2, but specialist oversight often preferred for steroids).
  • - Oral antihistamines may help systemic allergy symptoms.

Monitoring

Symptoms should improve within a few days with treatment (bacterial) or resolve spontaneously (viral). Follow up if symptoms worsen or do not improve.

Complications

  • Usually self-limiting.
  • Corneal involvement (keratitis) - rare with common conjunctivitis, more if severe infection (e.g., gonococcal) or inappropriate steroid use.
  • Chronic conjunctivitis.
  • Scarring (severe cases, e.g., trachoma - see OPH004).

Prevention

  • Good personal hygiene (hand washing).
  • Avoid sharing towels, eye makeup.
  • Avoiding allergens/irritants.
  • Prompt treatment of STIs (for gonococcal/chlamydial).

Patient education

  • Likely cause (bacterial, viral, allergic).
  • How to apply eye drops/ointment.
  • Importance of completing antibiotic course if prescribed.
  • Hygiene measures to prevent spread.
  • Expected duration of symptoms.
  • Symptoms indicating need for urgent review (pain, vision loss, photophobia).

Uganda-specific notes

Bacterial and viral conjunctivitis are common. Chloramphenicol and Tetracycline ointment are widely available. Allergic conjunctivitis also frequent. Steroid eye drops must be used cautiously due to risk of misuse/complications. Differentiate carefully from more serious causes of red eye.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 20, Section 20.1.2

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