Bacterial conjunctivitis is inflammation of the bulbar and tarsal conjunctiva arising from a broad group of bacterial pathogens. It is also known as "pink eye".

1. Bacterial
Conjunctivitis
Vinod Kumar Mugada
Associate Professor
Department of Pharmacy Practice
Vignan Institute of Pharmaceutical
Technology, Duvvada

2. Definition
Inflammation of the bulbar and tarsal
conjunctiva arising from a broad
group of bacterial pathogens. It is also
known as "pink eye".

3. Pathophysiology- disruption
Primary defense mechanism
Protective epithelial layer of the
conjunctiva
Secondary defense mechanisms
• Immune mechanisms
• Tear film immunoglobulins
• Lysozymes
• Rinsing action of lacrimation and
blinking

4. Common pathogens
1. Haemophilus influenzae- < 9
years
2. Staphylococcus
• Common in adults.
• May cause chronic conjunctivitis or
blepharitis
3. Pneumococcus- children
1. Pseudomonas- debilitated and
preterm infants
2. Streptococcus pneumoniae
3. Gonococcal conjunctivitis- major
threat to newborns exposed during
birth by an infected mother

5. History and Physical
•Pruritus
•Photophobia
•Blurred vision
•Discharge from eye
•Red eye
•Conjunctival finding
•Edema of eyelid

6. History and Physical
 Typical features of bacterial conjunctivitis are a
sandy, foreign body sensation, severe conjunctival
injection, lid edema, and mucopurulent to purulent
discharge.
 Involvement is unilateral initially, then rapidly
spreads to the other eye.
 Drying of the exudate may cause the lids to mat
and stick together.

7. History and Physical
 Pain and blurred vision are absent,
although discharge may cause a temporary
blurring.
 Conjunctival reaction is in a papillary
pattern, velvety appearing surface
sprinkled with numerous red dots.

8. Treatment
Most cases are
 Self-limited
 Resolve spontaneously within
10-14 days
Lack of improvement within 48 to 72 hours
indicates:
 Infection not responsive to antibiotic
 Non-bacterial cause
 Incorrect diagnosis
 Drug resistance

9. Treatment
 Methicillin-resistant Staphylococcus aureus infection
should be suspected in patients with nosocomial
conjunctivitis unresponsive to commonly used topical
antibiotics.
 Systemic therapy is indicated for all cases of gonococcal
and chlamydial conjunctivitis.
 Contact lenses should not be worn until symptoms have
resolved.

10. Drug Therapy
Polymyxin B/bacitracin
ointment is a drug of
choice for empiric
coverage of suspected
bacterial conjunctivitis.
Trimethoprim is
effective
against Pseudomonas
and other Gram-
negative bacilli

11. Drug Therapy
Sulfacetamide drops
(10% to 15%) or
ophthalmic ointment
(10%) are an alternative
to Polymyxin for empiric
treatment
Ophthalmic erythromycin
ointment is effective against all
Gram-positive and some Gram-
negative organisms,
including Neisseria,
Haemophilus,
and Corynebacterium.

12. Drug Therapy
Ceftriaxone is the
preferred drug for
treating gonococcal
ophthalmia in all age
groups, including
neonates
Erythromycin base or
ethyl succinate are the
drugs of choice for
treatment of neonatal
chlamydial conjunctivitis.

13. Drug Therapy
Because Neisseria
gonorrhoeae and Chlamydia
trachomatis infections often
coexist, patients being treated
for gonococcal conjunctivitis
should also be treated
presumptively for chlamydia
conjunctivitis
Ceftriaxone is a preferred
choice for patients with
acute purulent
conjunctival discharge
and Gram-negative cocci

14. Drug Therapy
Contact lens wearers require
antibiotic coverage such as
ciprofloxacin
for Pseudomonas infections.
Fluoroquinolones are associated with an
increased risk of tendinitis and tendon rupture
in all ages.
This risk is further increased in older patients
usually over 60 years of age, in patients
taking corticosteroid drugs, and in patients
with kidney, heart, or lung transplants.

15. Drug Therapy
Fluoroquinolones are known
to exacerbate muscle
weakness in patients with
myasthenia gravis due to
inherent neuromuscular
blocking activity and should
be avoided in these patients.
Physicians should advise patients
to stop taking the fluoroquinolone
at the first sign of tendon pain,
swelling, or inflammation, to avoid
exercise and use of the affected
area.

16. Drug Therapy
Suspected and known bacterial conjunctivitis
• Polymyxin B Sulfate /
Bacitracin
• Sulfacetamide Sodium
• Erythromycin
Suspected and known bacterial conjunctivitis
• Ciprofloxacin
• Trimethoprim
Hydrochloride /
Polymyxin B Sulfate

17. Drug Therapy
Gonococcal conjunctivitis
• Ceftriaxone
If allergic to ceftriaxone
• Ciprofloxacin
• Ofloxacin
• Spectinomycin
Hydrochloride

18. Drug Therapy
Chlamydial conjunctivitis
• Azithromycin
• Doxycycline
• Erythromycin
• Erythromycin ethyl
succinate
Suspected meningococcal conjunctivitis
• Ceftriaxone