QuestionSBA
QuestionChoice
This would be the appropriate management for blepharitis, which usually presents with dry eye. In allergic conjunctivitis, cold compresses (instead of hot) are advised to relieve symptoms of itchiness.
10038303
d
Advise gentle cleaning of the eyelid margins and hot compresses
QuestionChoice
This is an antibiotic eye drop used to treat bacterial conjunctivitis, which is more likely to present with purulent 'sticky' discharge. This patient's symptom of tearing suggests a more watery discharge. Even if bacterial conjunctivitis was suspected, most cases resolve spontaneously within 5-7 days without treatment. Antibiotic eye drops such as chloramphenicol are only indicated in severe cases or situations that require rapid resolution.
10038302
c
Prescribe chloramphenicol 0.5% QDS for 7 days
QuestionChoice
The most likely diagnosis in this scenario is allergic conjunctivitis given the patient's symptoms of red eye, watery discharge and itching. It is also commonly associated with other atopic conditions such as eczema, hay fever and asthma. According to [NICE guidelines](https://cks.nice.org.uk/topics/conjunctivitis-allergic/management/management-in-primary-care/#management-in-primary-care), the 1st line treatment is a topical mast cell stabilizer (sodium cromoglycate) and topical antihistamine (antazoline).
10038300
a
Prescribe topical sodium cromoglycate and antazoline drops
QuestionChoice
Given the most likely diagnosis of allergic conjunctivitis in this scenario, this can be managed in primary care in the first instance. There are no concerning symptoms or adverse features in the patient's history that would warrant an urgent same-day referral. NICE CKS provides some useful guidelines on [when to refer to secondary care in allergic conjunctivitis.](https://cks.nice.org.uk/topics/conjunctivitis-allergic/management/referral/)
10038301
b
Urgent referral for same-day ophthalmology assessment
QuestionChoice
Lubricating eye drops are used to relieve symptoms of dry eyes. It will not relieve the itchiness that this patient is presenting with.
10038304
e
Prescribe lubricating eye drops such as hypromellose to relieve symptoms
QuestionComment
womp womp

53837
User
subscriber
Eris
QuestionComment
not me knowing the answer was topical antihistamines but not knowing the names of them
53854
User
subscriber
Positive Whiff Test
QuestionComment
Opthalmology is impossible
55377
QuestionComment
u can do it :))
55725
User
subscriber
Recessive Tachycardia
User
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Thermoregulator Relapse
Concept
Chapter
# Summary
 
 
Conjunctivitis is an inflammation of the conjunctiva that can be either infectious or noninfectious. This condition is typically classified into allergic, viral, and bacterial types. Common symptoms include redness, pain, itchiness, and varying types of discharge from the eyes. The condition is diagnosed through physical examination and patient history. Management strategies largely depend on the underlying cause but may involve avoidance of allergens, use of artificial tears, or topical antibiotics in severe cases.
 
 
# Definition
 
 
Conjunctivitis, also known as ""pink eye,"" is a common condition that involves inflammation or infection of the conjunctiva, the transparent membrane that lines the eyelid and covers the white part of the eye. This condition can be either infectious (caused by bacteria or viruses) or noninfectious (due to allergies or other irritants).
 
 
# Epidemiology
 
 
While specific epidemiological data varies, conjunctivitis is a widely prevalent condition that affects people of all ages and demographics. It is especially common in children and can spread rapidly in schools and daycare centers. Its prevalence can also vary seasonally, particularly for allergic conjunctivitis which is often exacerbated during allergy season.
 
 
# Aetiology
 
 
Conjunctivitis can be caused by a variety of factors:
 
 
 - **Allergic conjunctivitis** is caused by a Type I hypersensitivity reaction to allergens in the environment. Common triggers include pollen, dust mites, and pet dander. This is the most common type of conjunctivitis, which tends to worsen at certain times of year or in particular environments.
 
 
 - **Viral conjunctivitis** is most often caused by adenoviruses but can also be caused by herpes simplex virus. It is highly contagious and often associated with upper respiratory tract infections or colds. This is the most common acute infectious cause.
 
 
 - **Bacterial conjunctivitis** is caused by bacterial infection. Common pathogens include Staphylococcus aureus, Staphylococcus epidermis, Streptococcus pneumoniae and Haemophilus influenzae. Sexually transmitted infections like gonorrhoea or chlamydia can also cause bacterial conjunctivitis, so it is important to take a sexual history if suspected.
 
 
 
# Signs and symptoms
 
 
 [lightgallery]
 
 
Common signs and symptoms of conjunctivitis include:
 
 
 - Eye redness
 - Itching
 - Irritation 
 - Excessive tearing
 - Discharge from the eyes, which can vary in consistency based on the cause. For example viral aetiologies produce a more watery discharge, wheres bacterial causes produce purulent discharge.
 - Photophobia, which suggests corneal involvement (keratoconjunctivitis) 
 
Notably, visual acuity should not be affected by conjunctivitis.
 
 **Red flags** for more serious causes of a red eye include:
 
 - Reduced visual acuity
 - Marked eye pain, headache, photophobia
 - Red sticky eye in a neonate
 - History of trauma or foreign body
 - Rapidly progressive discharge
 - Infection with herpes virus
 - Contact lens use
 - Pupil abnormalities or pain on constriction
 - Loss of red reflex
 - Blood or pus in the anterior chamber
 
 
# Differential diagnosis
 
 
The differential diagnosis for conjunctivitis includes a variety of conditions, each with their own distinct signs and symptoms:
 
 
 - **Dry eyes** – presents with dryness, burning, a feeling of something in the eye
 - **Corneal abrasion** – severe pain, photophobia, watering of the eye
 - **Uveitis** – eye pain, blurred vision, photophobia, floaters, redness
 - **Glaucoma** – severe eye pain, nausea, vomiting, blurred vision, halos around lights
 
 
# Investigations
 
 
The diagnosis of conjunctivitis is typically based on the patient's history and physical examination. In certain cases, conjunctival swabs for bacterial cultures may be taken, particularly if the patient does not respond to initial treatment, presents severe or unusual symptoms, or in cases of suspected gonococcal or chlamydial conjunctivitis.
 
 
# Management
 
 
The management of conjunctivitis depends on its cause:
 
 
 - **Allergic conjunctivitis** – Patients are advised to avoid allergens when possible and may be prescribed artificial tears, topical antihistamines, or mast cell stabilisers such as topical sodium cromoglycate.
 
 
 - **Viral conjunctivitis** – As this form is self-limiting, treatment focuses on symptom relief and prevention of spread through good hygiene practices.
 
 
 - **Bacterial conjunctivitis** – This form is also generally self-limiting, but in severe cases, topical antibiotics like chloramphenicol and fusidic acid may be recommended.
 - Conjunctivitis associated with contact lense wear should be managed with an aminoglycoside (e.g. gentamycin) or a quinolone (e.g. levofloxacin or moxifloxacin), to cover for gram -ve organisms. Patients should immediately stop wearing contact lenses until symptom resolution and antibiotic course completion.
 
 
In all cases, patients should be advised to seek medical attention if their condition worsens or fails to improve after a week of treatment.
 
 - If there is evidence of any red flag signs (see above), patients should be referred urgently to ophthalmology.
 
# NICE Guidelines
 
 
 [Click here for NICE CKS on allergic conjunctivitis](https://cks.nice.org.uk/topics/conjunctivitis-allergic/)
 
 [Click here for NICE CKS on infective conjunctivitis](https://cks.nice.org.uk/topics/conjunctivitis-infective/)
 
 [Click here for NICE CKS on red eye](https://cks.nice.org.uk/topics/red-eye/)
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Picture
A typical appearance of conjunctivitis.
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Conjunctivitis 2.jpeg
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JykGDwKoOFrUiKe/dYd5WIZ5a3r3L8EO
1020
Conjunctivitis
Topic
16
Ophthalmology
Condition
173
Conjunctivitis
UkmlaTopic
19
Ophthalmology
20019
For allergic conjunctivitis, prescribe sodium cromoglycate (1 drop, 2-4 times/day) to stabilize mast cells, and antazoline (1 drop, up to 3 times/day) to block histamine and relieve itching and redness.
Presentation
473
Red eye
UkmlaTopic
19
Ophthalmology
A 19-year-old man presents to the GP clinic with redness in both eyes that developed over the past week. He also complains of tearing and an itchy sensation around his eyes. He has never experienced these symptoms before. He has a past medical history of eczema as a child and takes over-the-counter antihistamines for hay fever. He is otherwise well in himself.

Given the most likely diagnosis, what is the most appropriate course of action?
a