OP3.2 | Acute Conjunctivitis: Bacterial and Viral Patterns — Summary & Reflection

KEY TAKEAWAYS

Acute conjunctivitis is classified as bacterial (mucopurulent discharge, papillary reaction, no preauricular node) or viral (watery discharge, follicular reaction, preauricular lymphadenopathy). The conjunctival reaction — papillary (vascular core, bacterial/allergic) vs follicular (avascular lymphoid aggregate, viral/chlamydial) — is the key clinical discriminator on eversion of the upper lid. Bacterial causes: Staphylococcus aureus (most common in adults), Haemophilus influenzae (children), Streptococcus pneumoniae; hyperacute gonococcal — requires systemic ceftriaxone urgently; neonatal conjunctivitis (N. gonorrhoeae day 1–3, Chlamydia day 5–14). Viral causes: Adenovirus — PCF (types 3/4/7, pharyngitis + fever) and EKC (types 8/19/37, subepithelial infiltrates from day 7–14); AHC (Enterovirus 70/Coxsackievirus A24 — haemorrhagic, epidemic). Treatment: topical chloramphenicol or ciprofloxacin for bacterial; supportive only for viral — antibiotics are NOT indicated. EKC: 2-week exclusion from clinical settings. Ophthalmia neonatorum: systemic treatment required for both gonococcal and chlamydial forms.

REFLECT

In your clinical or laboratory training, have you ever seen a child or adult with conjunctivitis who was prescribed antibiotics without a clear bacterial diagnosis? Reflecting on what you now know about papillary vs follicular reaction and the viral aetiology of most acute conjunctivitis, what information would you have needed to determine whether antibiotics were appropriate? How would you counsel a patient who asks you 'Why are you not giving me eye drops for my red eye?' Write two sentences for your reflective portfolio.