Conjunctivitis, commonly known as eye flu, is an inflammation of the conjunctiva that causes redness, irritation, and discomfort.
Frequently Asked Questions
How do I differentiate viral, bacterial, and allergic conjunctivitis clinically?
Clinical differentiation guide: VIRAL CONJUNCTIVITIS — Typical: adenovirus outbreak setting; started in one eye, spread to other in 2-4 days; watery discharge (not thick pus); foreign body sensation; often preceded by URTI/cough/cold; pre-auricular lymph node tender (in front of ear); highly contagious; self-limiting 7-14 days. BACTERIAL CONJUNCTIVITIS — Thick yellow-green mucopurulent discharge; eyelids stuck together on waking; usually one eye (spreads if untreated); less pre-auricular node involvement; responds to antibiotic drops in 24-48 hours; if not resolving, consider gonococcal (severe hyperacute) or chlamydial (chronic follicular); staphylococcus, streptococcus, haemophilus are common. ALLERGIC CONJUNCTIVITIS — Both eyes always; intense itching (dominant symptom); watery/mucoid stringy discharge; puffy pink-white swelling of conjunctiva (chemosis); often personal/family history of atopy, asthma, eczema; seasonal patterns; not contagious; papillae on tarsal conjunctiva visible on lid eversion; long-term treatment needed. Diagnostic clues: watery discharge = viral; thick pus = bacterial; itching = allergic. Fluorescein staining rules out corneal involvement (keratitis). Bilateral pain + photophobia + vision reduction = suspect keratitis or iritis (NOT simple conjunctivitis) — needs ophthalmologist urgently.
What is the treatment protocol for conjunctivitis in primary care?
Treatment depends on the likely aetiology. VIRAL CONJUNCTIVITIS: cold compresses, preservative-free artificial tears 4-6 times daily, avoid contact lenses, and strict hygiene/isolation for 7-14 days; NO antibiotic drops (widely misused for viral cases); NO steroid drops without ophthalmologist supervision. BACTERIAL CONJUNCTIVITIS: topical antibiotic drops — moxifloxacin 0.5%, ciprofloxacin 0.3%, or tobramycin 0.3%, one drop four times daily for 5-7 days; add ointment at bedtime if lid crusting is significant; combined with hygiene measures, usually resolves in 3-5 days. ALLERGIC CONJUNCTIVITIS: cool compresses, artificial tears, and a topical antihistamine + mast cell stabiliser combination (olopatadine 0.1% or ketotifen 0.025% twice daily); severe cases may need a brief course of low-potency topical steroid (fluorometholone 0.1%) 4x daily for 5-7 days under ophthalmologist supervision; long-term allergen avoidance matters; oral antihistamine (cetirizine or levocetirizine) if there are systemic allergic symptoms. SUSPECTED GONOCOCCAL conjunctivitis (hyperacute severe swelling, copious pus in an adult with unprotected sexual contact) is a MEDICAL EMERGENCY needing ceftriaxone IM + saline lavage + urgent ophthalmology referral. HERPES SIMPLEX suspected (unilateral, dendritic corneal ulcer visible on fluorescein) needs trifluridine drops, acyclovir ointment, and urgent ophthalmology — NEVER topical steroids initially. Escalate to ophthalmologist if: symptoms over 7-10 days, worsening despite treatment, pain, vision loss, photophobia, contact lens wearer, immunocompromised, or neonate.
How should conjunctivitis be managed in contact lens wearers?
Contact lens wearers with red eye require special caution because of higher risk of microbial keratitis (potentially blinding infection) — often misdiagnosed as ‘eye flu’: (1) STOP wearing contact lenses immediately at first sign of redness/discomfort — this alone prevents progression in many cases; (2) See ophthalmologist within 24 hours (NOT optometrist alone) — need slit lamp examination with fluorescein to rule out corneal ulcer; (3) Do NOT self-medicate with steroid drops (can dramatically worsen infection); (4) Culture contact lens case, contact lens, and eye scrapings if ulcer suspected; (5) Do not restart lens wear until: eye white completely non-red, no symptoms for 3-5 days, ophthalmologist clearance; (6) Discard old lenses and case; replace with new pair; (7) Review lens hygiene practices — sleep habits with lenses, lens replacement schedule, cleaning solutions, tap water contact (never rinse lenses in tap water; documented Acanthamoeba keratitis in India). India-specific risks: humid climate, water quality issues, monsoon season swimming pool exposure, high UV exposure, air pollution. Common Indian contact lens problems: (1) Overwearing daily disposables; (2) Sleeping in monthly lenses; (3) Rinsing/storing in tap water; (4) Sharing lenses (never!); (5) Reusing solution; (6) Poor hand hygiene before insertion. Educate patients on proper care; refer to ophthalmologist for any red eye in lens wearer — better to over-refer than miss keratitis.
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