BACTERIAL CONJUNCTIVITIS

            BACTERIAL CONJUNCTIVITIS

Bacterial conjunctivitis --

Bacterial conjunctivitis is also very contagious. An infection from bacteria causes this form of pink eye. With bacterial conjunctivitis, you have sore, red eyes with a lot of sticky pus, 
this type of conjunctivitis can cause serious damage to the eye if left untreated. Some bacterial infections, however, may cause little or no discharge. Both bacterial and viral conjunctivitis is easily spread from person to person.

Bacterial and viral conjunctivitis can be quite contagious. The most common ways to get the contagious form of pink eye include:

• Direct contact with an infected person's bodily fluids, usually through hand-to-eye contact.
• Spread of the infection from bacteria living in the person's own nose and sinuses.
• Not cleaning contact lenses properly. Using poorly fitting contact lenses or decorative contacts are risks as well.

Children are the people most likely to get pink eye from bacteria or viruses. This is because they are in close contact with so many others in school or daycare centers. Also, they don't practice good hygiene.

ORGANISM-- 

Staphylococcus aureus,

 Streptococcus pneumoniae, 

 Streptococcus viridans, 

RISK FACTORS---

• Since these bacteria are usually spread from other infected individuals, poor hygenic habits may increase the risk of infection 
• Poor contact lens hygiene
• Contaminated cosmetics
• Crowded living or social conditions such as elementary schools, military barracks, etc
• Ocular diseases including dry eye, blepharitis, and anatomic abnormalities of the ocular surface and lids
• Recent ocular surgery, exposed sutures or ocular foreign bodies
• Chronic use of topical medications
• Immune compromise

Symptoms

• Red-eye: Either unilateral, bilateral, or sequentially bilateral
• Discharge: Classically purulent, but may be thin or thick mucopurulent or watery
• Irritation, burning, stinging, discomfort
• Tearing
• Light sensitivity
• Intolerance to contact lens
• Fluctuating or decreased vision

Signs

• Bulbar conjunctival injection
• Palpebral conjunctival papillary reaction
• Muco-purulent or watery discharge

• Chemosis
• Lid erythema

INVESTIGATION-- 

• Gram stain & Cultures
• RPS Adeno Detector

MANAGEMENT--

Almost all cases of acute bacterial conjunctivitis are self-limited and will clear within 10 days without treatment. However, there are some more virulent organisms that may go on to cause chronic colonization and symptoms. Furthermore, antibiotic treatment has been shown to decrease the duration of symptoms and speed the eradication of microorganisms from the conjunctival surface. 

General treatment

Bacterial conjunctivitis is a contagious condition, so patients are instructed in proper hygiene and handwashing. The exact period of time of contagion cannot be predicted and the amount of time suggested varies, with a recent survey of ophthalmologists recommending 1 - 3 days away from work or until the infection clears.

Supportive therapy for conjunctivitis consists of cool compresses and artificial tears two-six times daily. 

Medical therapy

Antibiotics may lead to quicker clinical and microbiological remission compared with placebo, at least in the first 2-5 days of therapy. This may result in decreased transmission of the disease and lower incidences within the population.

Many antibiotics have been shown to be equivalent in the treatment of routine cases, and therefore the choice of antibiotics is often guided by cost, availability, and risk of side effects.

The most common antibiotics used for acute bacterial conjunctivitis are as follows:

• Fluoroquinolones:
  • 2nd generation: Ciprofloxacin 0.3% drops or ointment, or Ofloxacin 0.3% drops
  • 3rd generation: Levofloxacin 0.5% drops
  • 4th generation: Moxifloxacin 0.5% drops, Gatifloxacin 0.5% drops, or Besifloxacin 0.6% drops
• Aminoglycosides:
  • Tobramycin 0.3% drops
  • Gentamicin 0.3% drops
• Macrolides:
  • Erythromycin 0.5% ointment
  • Azithromycin 1% solution

• Other
  • Bacitracin ointment
  • Bacitracin/Polymixin B ointment
  • Neomycin/Polymixin B/Bacitracin
  • Neomycin/Polymixin B/gramicidin
  • Polymixin B/Trimethoprim
  • Sulfacetamide