eMedicine Specialties > Ophthalmology > Conjunctiva

Conjunctivitis, Bacterial: Follow-up

Author: David S Marlin, MD, Consulting Staff, Department of Ophthalmology, Kaiser Foundation Hospital, Los Angeles Medical Center
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Further Inpatient Care

  • Inpatient care for bacterial conjunctivitis would be provided only in the setting of hospitalization for other reasons. It is important to realize that, in the inpatient setting, the differential diagnosis must be carefully considered since the patients tend to be ill. Therefore, it is more common to see a red eye due to endogenous endophthalmitis or an infected corneal ulcer in this population.
  • Serious consideration should be given to admitting patients with hyperacute bacterial conjunctivitis if the entire cornea cannot be visualized, as there may be an early corneal ulceration, especially in Neisseria infections. Topical antibiotic, proper hygiene, and isolation are considerations for these patients.

Deterrence/Prevention

  • Hygiene and avoidance of close contact accomplish deterrence of bacterial conjunctivitis with infected individuals.

Complications

  • Bacterial conjunctivitis seldom leads to complications. General concerns include membrane formation and subsequent scarring of the punctum; corneal ulcer when the epithelium is not intact; and symblepharon from severe inflammation.
  • In eyes with previous intraocular surgery, particularly with filtering blebs, endophthalmitis could result.

Prognosis

  • The prognosis for complete recovery without sequelae is excellent in bacterial conjunctivitis.
  • Only cases with extremely pathogenic bacteria, such as Chlamydia trachomatis or N gonorrhoeae, are expected to develop complications.

Patient Education

  • Patients and household members should be educated to pay attention to hygiene and the avoidance of close contact with the infected individual.

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal concerns do arise in connection with bacterial conjunctivitis. As with all medical practice, careful discussion and documentation is paramount. A few general guidelines are helpful.
    • Know the differential diagnosis.
    • Perform an eye examination and, in particular, document that iritis and acute glaucoma have been ruled out.
    • The physician should be aware of more unusual conditions, such as carotid-cavernous fistula.
    • Always consider Chlamydia or N gonorrhoeae in the differential diagnosis. Be sure to treat systemically and ask for advice from other specialists when needed.
    • Instruct patients to report to the clinic if they do not recover completely in a timely manner, so that therapy can be reassessed.
    • Consider culture and conjunctival scrapings for resistant cases.
    • Be aware of drug alerts, such as the one in early 2006 related to a contaminated commercial contact lens solution.

Special Concerns

  • Of special concern is the care of ophthalmia neonatorum. The practitioner should make sure that appropriate prophylaxis is administered and that suspected cases are managed properly. 
  • Also of special concern is trachoma, a devastating disease. See Trachoma.
 


More on Conjunctivitis, Bacterial

Overview: Conjunctivitis, Bacterial
Differential Diagnoses & Workup: Conjunctivitis, Bacterial
Treatment & Medication: Conjunctivitis, Bacterial
Follow-up: Conjunctivitis, Bacterial
References
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References

  1. Hammerschlag MR, Cummings C, Roblin PM, Williams TH, Delke I. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med. Mar 23 1989;320(12):769-72. [Medline].

  2. Rapoza PA, Quinn TC, Kiessling LA, Taylor HR. Epidemiology of neonatal conjunctivitis. Ophthalmology. Apr 1986;93(4):456-61. [Medline].

  3. Schachter J, Lum L, Gooding CA, Ostler B. Pneumonitis following inclusion blennorrhea. J Pediatr. Nov 1975;87(5):779-80. [Medline].

  4. Tabbara KF, Hyndiuk RA. Infections of the Eye. Little, Brown and Company; 1996.

  5. Ullman S, Roussel TJ, Culbertson WW, Forster RK, Alfonso E, Mendelsohn AD, et al. Neisseria gonorrhoeae keratoconjunctivitis. Ophthalmology. May 1987;94(5):525-31. [Medline].

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Further Reading

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Keywords

bacterial conjunctivitis, eye infection, pink eye, red eye

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Contributor Information and Disclosures

Author

David S Marlin, MD, Consulting Staff, Department of Ophthalmology, Kaiser Foundation Hospital, Los Angeles Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Jerre Freeman, MD, Founder, Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center
Jerre Freeman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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