Conjunctivitis and chloramphenicol
The conjunctiva is a highly vascularised mucous membrane. It covers the white of the eye (the sclera) and the inner surfaces of the eyelids (see Figure 1). The conjunctiva protects the sclera and decreases friction when we blink.
Conjunctivitis means inflammation of the conjunctiva. There are four main types of conjunctivitis: bacterial, adenoviral, allergic and chlamydial. It is also possible for a foreign body on the conjunctiva to cause conjunctivitis. Conjunctivitis may be accompanied by soreness or discomfort, but the presence of pain is a sign that something else is wrong.
Bacterial conjunctivitis is more common in infants and children than in adults. In adults, 55 per cent of bacterial conjunctivitis is caused by Staphylococcus aureus, 20 per cent by Streptococcus pneumoniae, 10 per cent by Moraxella spp, 5 per cent by Haemophilus influenzae and 5 per cent by Pseudomonas aeruginosa. Staphylococcus and streptococcus are Gram positive bacteria, haemophilus and pseudomonas are Gram negative bacteria and moraxella is Gram variable. In infants and children, the most common bacteria causing conjunctivitis are Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae.
In bacterial conjunctivitis, the eye is usually red because blood vessels dilate, and there is nearly always a yellow purulent discharge. So, a useful question to ask the patient (or child’s parent) is: When you (or your child) woke up, were the eyelashes stuck together with a yellow discharge and did you have to wipe this away? If the answer is “yes”, then the patient nearly always has a bacterial conjunctivitis.
Bacterial conjunctivitis is usually self-limiting — it takes seven to 10 days to resolve. However, most patients (or parents) will want immediate treatment and an antibiotic preparation could be prescribed or sold. The patient should be told to take care not to touch the infected eye and then touch the unaffected eye because this could transfer the infection. Eye make up could also be contaminated and should be replaced.
Adenoviral conjunctivitis is more common in adults than in children. Adenoviruses are also implicated in causing the common cold (rhinoviruses are the main cause). Ten of the 31 serotypes of adenovirus have been implicated in causing conjunctivitis, with types 8 and 19 being the most frequent cause.1
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Citation: The Pharmaceutical Journal URI: 10997319
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