Symptoms and Treatment of Bacterial Conjunctivitis
Bacterial conjunctivitis typically presents with redness, purulent discharge, mattering and adherence of eyelids on waking, and absence of itching. 1, 2 These symptoms distinguish it from viral or allergic conjunctivitis and guide appropriate treatment.
Symptoms of Bacterial Conjunctivitis
Key Clinical Signs
- Unilateral or bilateral (often sequentially bilateral) presentation
- Bulbar conjunctival injection (redness)
- Purulent or mucopurulent discharge (yellow-green)
- Mattering and adherence of eyelids upon waking
- Absence of significant itching (distinguishes from allergic conjunctivitis)
- Mild discomfort rather than severe pain
- Minimal to no effect on visual acuity (unless complications develop)
Distinguishing Features from Other Types of Conjunctivitis
- Viral conjunctivitis: Presents with watery discharge, follicular reaction, preauricular lymphadenopathy, and often follows upper respiratory infection 1
- Allergic conjunctivitis: Characterized by severe itching, watery discharge, and history of allergies 1
- Herpes simplex conjunctivitis: Usually unilateral with watery discharge and possible vesicular skin lesions 1
Treatment Approach
Mild Bacterial Conjunctivitis
- Often self-limited in immunocompetent adults and may resolve without treatment in 1-2 weeks 1
- Topical antibiotics hasten clinical and microbiological remission in days 2-5 of treatment 1
- Recommended regimen: One or two drops of antibiotic solution instilled into the conjunctival sac every 2 hours while awake for 2 days, then every 4 hours while awake for 5 more days 3
- Common antibiotics include fluoroquinolones, aminoglycosides, and macrolides 2
Moderate to Severe Bacterial Conjunctivitis
- Characterized by copious purulent discharge, pain, and marked inflammation 1
- Conjunctival cultures and Gram staining should be obtained if gonococcal infection is suspected 1
- More aggressive antibiotic therapy guided by laboratory results
- Monitor for corneal involvement which requires more intensive treatment
Special Considerations
- Contact lens wearers: Higher risk of Pseudomonas infection; require antibiotic treatment even for mild cases 2
- Gonococcal conjunctivitis: Requires systemic antibiotics (ceftriaxone 1g IM single dose) plus ocular saline lavage 2
- Chlamydial conjunctivitis: Requires systemic treatment with azithromycin 1g orally single dose or doxycycline 100mg orally twice daily for 7 days 2
Prevention and Infection Control
- Frequent handwashing
- Avoid touching or rubbing eyes
- Use separate towels and pillows
- Proper disinfection of surfaces and equipment
- Avoid close contact during contagious period 2
When to Refer to an Ophthalmologist
- Visual loss
- Moderate to severe pain
- Severe purulent discharge unresponsive to initial therapy
- Corneal involvement
- Lack of response to therapy within 3-4 days
- Recurrent episodes
- Immunocompromised patients 2
Potential Complications
- Conjunctival scarring
- Corneal involvement leading to keratitis
- Subepithelial infiltrates
- Dry eye syndrome
- In severe cases, corneal perforation and endophthalmitis 1, 2
Bacterial conjunctivitis is generally a self-limiting condition, but appropriate antibiotic treatment shortens the course of disease, reduces contagious spread, and prevents potential complications, particularly in moderate to severe cases.