Conjunctivitis Acute inflammation of the conjunctiva caused by a bacterial or viral infection, allergy, irritation. Endemic or epidemic, it is sometimes associated with measles or nasopharyngitis in children. In the absence of hygiene and effective treatment, it can be complicated by a bacterial infection, an infringement of the cornea (keratitis) and eventually blindness.

Clinical signs:

– Common to all conjunctivitis: conjunctival redness; discomfort of sand in the eye; normal vision.

– Depending on the cause:

• abundant secretions, purulent, eyelids stuck together on waking, unilateral infection early: bacterial conjunctivitis;

• watery secretions, significant tearing, no itching: viral conjunctivitis;

• High tearing, eyelid edema, intense itching: allergic conjunctivitis.

– In endemic areas, turn the upper eyelid 2 eyes to check for signs of trachoma.

– Suspect keratitis severe pain, significantly higher than during conjunctivitis, associated with photophobia. Instill one drop of 0.5% fluorescein to search ulceration.

– Always look for a foreign body subconjunctival or corneal and remove after instillation of a drop (maximum 2 drops) of anesthetic drops oxybuprocaine 0.4% (never to the eye drop bottle to the patient).

Treatment:

– Bacterial Conjunctivitis

• Clean the eyes, 4-6 times / day with boiled water or sodium chloride 0.9%.

• Apply tetracycline eye ointment 1%, 2 times / day, in 2 eyes, for 7 days.

• Do not use ointment or eye drops containing corticosteroids.

– Viral Conjunctivitis

• Clean the eyes, 4-6 times / day with boiled water or sodium chloride 0.9%.

• Local Antibiotic if (risk of) bacterial infection (tetracycline eye ointment).

– Allergic conjunctivitis

• Local treatment as for viral conjunctivitis.

• Antihistamines for 1 to 3 days: promethazine PO

Children 2 to 5 years 5 to 15 mg / day taken 1-2

Children from 5 to 10 years: 10 to 25 mg / day taken 1-2

Children over 10 years and adults: 25 to 50 mg / day in 1-2 doses or chlorphenamine PO

Children from 1 to 2: 1 mg 2 times a day

Children 2 to 6 years: 1 mg 4-6 times a day

Children 6 to 12 years: 2 mg 4-6 times a day

Adult: 4 mg 4 to 6 times per day

Note: in the presence of a foreign body, check tetanus prophylaxis.

Conjunctivitis Newborn

Contamination of the newborn during childbirth when the mother is suffering from a genital infection gonorrhea and / or chlamydia.

Clinical signs:

– Purulent conjunctivitis within the first 28 days of life.

– Conjunctivitis, gonococcal: bilateral in 50% of cases, occurring on average 2-7 days after birth. This is a severe, highly contagious, rapidly progressing to severe corneal damage (risk of blindness).

– Conjunctivitis chlamydial: often unilateral, occurring on average 5 to 14 days after birth.

Prevention:

Immediately after birth:

– Clean eyelids with sterile sodium chloride 0.9%.

– 1% tetracycline eye ointment: an application in each eye

Otherwise: use silver nitrate 1%, one drop in each eye. This product is however more toxic and poses preparation and conservation issues incompatible with the isolation situations.

Note :

If maternal infection with the herpes simplex virus at the time of delivery:

– Clean the eyelids as above.

– First apply acyclovir ophthalmic ointment 3% in each eye and wait 12 hours to implement the 1% ophthalmic tetracycline ointment.

Treatment:

At the clinic:

This is a medical emergency, refer. When can hospitalize immediately, clean and apply 1% tetracycline eye ointmentin 2 eyes, every hour, awaiting transfer to systemic therapy.

To the hospital :

– Isolate the child 24 to 48 hours if possible.

– The treatment of choice is ceftriaxone IM: 50 mg / kg single dose (not to exceed 125 mg) if the eye localized infection.

Otherwise, use spectinomycin IM: 25 mg / kg single dose (not to exceed 75 mg).

– Meanwhile, clean the eyes (risk of adhesion) with a sterile isotonic saline (sodium chloride 0.9% or Ringer’s lactate) and apply tetracycline eye ointment 1%, 4 times / day.

– When can immediately treat systemically apply tetracycline eye ointment 1% in 2 eyes, every hour, until the treatment is available.

– Treat the mother and her partner.

– In case of failure of ceftriaxone, treating chlamydia:

erythromycin PO: 50 mg / kg / day divided into 2 or 3 doses for 14 days