Excerpt from Conjunctivitis, Bacterial

Synonyms, Key Words, and Related Terms: bacterial conjunctivitis, eye infection, pink eye, red eye

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Background: Bacterial conjunctivitis is a microbial infection involving the mucous membrane of the surface of the eye. This condition, which is usually a benign self-limited illness, sometimes can be serious or signify a severe underlying systemic disease. Occasionally, significant ocular and systemic morbidity may result. The purpose of this article is to help the practitioner recognize the character and significance of the condition, avoid pitfalls in diagnosis, and to convey appropriate treatment modalities.

Pathophysiology: 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. An alteration in the flora can occur by external contamination, by spread from adjacent sites, or via a blood-borne pathway.

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.

Frequency:

In the US: Bacterial conjunctivitis is a common condition in all areas of the United States. It is likely that most people will experience an episode. Most of the benign cases probably are treated by primary physicians or resolve spontaneously.

Internationally: Bacterial conjunctivitis is common worldwide. Community sequelae can be devastating in areas affected by blinding infections of newborns as well as in areas heavily affected by Chlamydia trachomatis.

Mortality/Morbidity: Mortality in the setting of bacterial conjunctivitis is related to the failure to recognize and treat the underlying disease. Sepsis and meningitis caused by Neisseria gonorrhoeae can be life threatening. Chlamydial infection in the newborn can lead to pneumonia and/or otitis media. Morbidity in terms of discomfort, ocular discharge, and redness are common in benign cases and often lead to absence from work and school. 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.

Race:

Bacterial conjunctivitis occurs in all races.

Differences in frequencies among races are likely to reflect geographical variations in the prevalence of pathogens.

Sex:

Probably, both sexes have an equal natural resistance to bacterial conjunctivitis.

Differences in rates of infection probably reflect behavioral patterns such as the exposure of female elementary school teachers to children affected by the condition.

Age:

Age is a relevant factor in the significance of bacterial conjunctivitis.

The practitioner must be vigilant in considering sexually transmitted diseases caused by N 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. It is important not to violate HIPPA Regulations during history taking and treatment. If a practitioner is mirted in an ethical or medicolegal situation, it is a good idea to seek advice from administration and/or colleagues.