Bacterial Conjunctivitis 

Inflammation of the bulbar and/or palpebral conjunctiva, or conjunctivitis, can be caused by allergies, viruses, or bacteria. Bacterial conjunctivitis is commonly caused by staphylococci, streptococci, chlamydial organism, and gonocci. Mild conjunctivitis is usually benign and self-limited and can be easily treated with antibiotics. Severe conjunctivitis, such as that caused by gonococci, can cause blindness and can signify a severe underlying systemic disease.

The purpose of this article is to( 1) help the practitioner recognize the characteristics and significance of the condition, (2) avoid pitfalls in diagnosis, and (3) convey appropriate treatment modalities. Conjunctival scrapings and cultures are commonly used to confirm the microbe in severe and bacterial conjunctivitis and that resistant to antibiotic treatment (see Workup). The mainstay of treatment of bacterial conjunctivitis is topical antibiotic therapy. Systemic antibiotics are indicated for Neisseria gonorrhoeae and chlamydial infections. Surgical intervention is required only if the cornea is involved and results in corneal opacification (see Treatment).

See the following for more information:

• Acute Hemorrhagic Conjunctivitis
• Allergic Conjunctivitis
• Atopic Keratoconjunctivitis
• Emergent Treatment of Acute Conjunctivitis
• Epidemic Keratoconjunctivitis
• Giant Papillary Conjunctivitis
• Keratoconjunctivitis Sicca
• Neonatal Conjunctivitis
• Superior Limbic Keratoconjunctivitis
• Viral Conjunctivitis

The surface tissues of the eye and the ocular adnexa are colonized by normal flora such as streptococci, staphylococci, and Corynebacterium strains. Alterations in the host defense or in the species of bacteria can lead to clinical infection. Alteration in the flora can occur by external contamination (eg, contact lens wear, swimming) or spread from adjacent infectious sites (eg, rubbing of the eyes).

The primary defense against infection is the epithelial layer covering the conjunctiva. Disruption of this barrier can lead to infection. Secondary defenses include hematologic immune mechanisms carried by the conjunctival vasculature; tear film immunoglobulins and lysozyme; and the rinsing action of lacrimation and blinking.

Bacterial conjunctivitis most often occurs in otherwise healthy individuals. Risk factors include frequent exposure to infected individuals, contact lens wear, sinusitis, immunodeficiency states, and exposure to agents of sexually transmitted disease at birth.

Bacterial conjunctivitis is common worldwide. Most benign cases are treated with topical antibiotics or can resolve spontaneously. Internationally, isolated epidemics can be devastating in areas affected by blinding infections of newborns, especially in areas heavily affected by Chlamydia trachomatis.^[2]

Racial and sexual differences in incidence

Bacterial conjunctivitis occurs in persons of all races, although differences in frequencies may be reflected by geographical variations of pathogen prevalence.

Males and females have equal natural resistance to bacterial conjunctivitis. Differences in infection rates may reflect environmental and behavioral patterns, such as the exposure of female elementary school teachers to children affected by the condition.

Age-related differences in incidence

Age is a relevant factor in the significance of bacterial conjunctivitis. The practitioner must be vigilant in considering sexually transmitted diseases caused by Neisseria gonorrhoeae and Chlamydia in sexually active age groups and in newborns who may have been exposed during birth. Tactful and confidential history taking are a necessary skill so as not to violating HIPPA regulations. In an ethical or medicolegal situation, obtaining advice from administration and/or colleagues is recommended.

The prognosis for complete recovery without sequelae is excellent in bacterial conjunctivitis, as long as the cornea is not involved. Complications are expected to develop only in cases caused by extremely pathogenic bacteria, such as Chlamydia trachomatis or N gonorrhoeae.

Mortality in the setting of bacterial conjunctivitis is related to the failure to recognize and treat the underlying disease. Sepsis and meningitis caused by N gonorrhoeae can be life threatening.^[3] Chlamydial infection in the newborn can lead to pneumonia and/or otitis media.^[4]

Signs and symptoms of discomfort, mucopurulent ocular discharge, and conjunctival redness are common in benign cases and often lead to absence from work and school to minimize infection to others. Morbidity can be associated with misdiagnosis. Since many eye diseases cause the eye to be red, it is beneficial to have a solid approach to diagnosis.