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
Viral epidemic keratoconjunctivitis (damage to the cornea and conjunctiva)
– Treat as viral conjunctivitis. Refer to an ophthalmologist if possible.
– Occlusive dressing for the duration of the photophobia. Remove it as soon as possible.
– Depending on the context, to associate a preventive dose treatment with vitamin A.