Bacterial conjunctivitis

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

Bacterial conjunctivitis is caused by numerous bacteria. Symptoms are hyperemia, tearing, irritation and discharge. The diagnosis is established clinically. Treatment is the use of local antibiotics, enhanced by systemic antibiotics in more severe cases.

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Causes of bacterial conjunctivitis

Infection with bacterial conjunctivitis usually occurs as a result of direct contact with infected discharge.

Bacterial conjunctivitis is usually caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus sp. Or less often Chlamydia trachomatis, Neisseria gonorrhoeae causes gonococcal conjunctivitis, which is usually the result of sexual contact with a person with a urogenital infection.

Ophthalmia of the newborn is conjunctivitis, which occurs in 20–40% of children born through the infected birth canal. This disease may be associated with maternal gonococcal or chlamydial infection.

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Symptoms of bacterial conjunctivitis

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

Eyelids crusted, swollen. The discharge initially is most often watery, resembling viral conjunctivitis, but within about 1 day it becomes mucopurulent. In the lower arch can detect mucus in the form of threads. The most pronounced hyperemia - in the arch and less - at the limbus. Tarsal conjunctiva velvety, red, with moderate papillary changes. Often there are superficial epitheliopathy and epithelial erosion, which are often safe.

The conjunctiva of the eyelids and the eyeball is intensely hyperemic and edematous. There are usually no petechial subconjunctival hemorrhages, chemosis, eyelid edema, and enlarged prelimite lymph nodes.

In adults with gonococcal conjunctivitis, symptoms develop 12–48 hours after exposure. There are marked swelling of the eyelids, chemosis and purulent exudate. Rare complications include corneal ulceration, abscess, perforation, panophthalmitis, and blindness.

Ophthalmia of the newborn as a result of gonococcal infection manifests 2-5 days after delivery. Symptoms of neonatal ophthalmia as a result of chlamydial infection appear after 5-14 days. Symptoms are bilateral, there is a pronounced papillary conjunctivitis with eyelid edema, chemosis, and mucopurulent discharge.

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Diagnosis of bacterial conjunctivitis

Smears and bacterial cultures should be made with symptoms expressed, in immunocompromised patients, with unsuccessful primary therapy and with risk factors (for example, after corneal transplantation, with exophthalmos due to Graves' disease). Conjunctival swabs and scrapings should be microscopically examined and Gram-stained to identify bacteria and Giemsa to identify characteristic bodies included in the basophilic cytoplasm of epithelial cells in chlamydial conjunctivitis.

Treatment of bacterial conjunctivitis

Bacterial conjunctivitis is very 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 7–10 days with 0.5% moxifloxacin drops 3 times a day, or other fluoroquinolone or trimethoprim / polymyxin B 4 times a day. The low effectiveness of treatment after 2-3 days indicates that the disease is of viral or allergic nature or there is resistance of bacteria to the prescribed treatment. Seeding and sensitivity testing to antibiotics determine subsequent treatment.

Gonococcal conjunctivitis in adults requires a single dose of ceftriaxone 1 g intramuscularly or ciprofloxacin 500 mg 2 times a day for 5 days. In addition to systemic treatment, bacitracin 500 units / g or 0.3% gentamicin eye ointment, applied to the affected eye, can be used. Sexual partners must also be treated. Since patients with gonorrhea often have chlamydial urogenital infection, patients should also receive a single dose of 1 mg of azithromycin or doxacycline 100 mg 2 times a day for 7 days.

Neonatal ophthalmia is prevented by using drops of silver nitrate or erythromycin at birth. Infections that have not been cured in this way require systemic therapy. When gonococcal infection ceftriaxone is prescribed at 25-50 mg / kg intravenously or intramuscularly 1 time per day for 7 days. Chlamydial infection is treated with erythromycin 12.5 mg / kg 4 times a day for 14 days. Parents should also be treated.

Even without the absence of treatment, simple bacterial conjunctivitis usually lasts 10-14 days, so laboratory tests are usually not performed. Before starting treatment of bacterial conjunctivitis, it is important to clear the eyelids and remove discharge from them. Until the discharge stops, you need to apply broad spectrum antibacterial agents throughout the day in the form of drops and at bedtime - as an ointment.

Antibiotics in the form of drops

• Fuzidaeba acid (fucitalmic) - a viscous suspension, which is used for infection of staphylococcal nature, but it is not effective against most gram-negative microorganisms. Initial treatment - 3 times a day for 48 hours, then 2 times a day;
• chloramphenicol has a wide spectrum of action, and it is initially prescribed every 1-2 hours;
• other antibacterial drugs: ciprofloxacin, ofloxacin, lomefloxacin, gentamicin, neomycium, framycitin, tobromycin, neosporin (polymyxin B + neomycin + gramicidin) and polytrim (polymyxin + trimethoprim).

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Antibiotics as an ointment

Antibiotics in the form of ointments provide a higher concentration over a long period than drops, but their use during the day should be limited, as they cause an erased course of the disease. Ointment is best used overnight to ensure a good concentration of antibacterial drug during the entire sleep.

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

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