The document presents a seminar on bacterial conjunctivitis, highlighting its causes, prevalence, symptoms, diagnosis, and management. Bacterial conjunctivitis is highly contagious, typically characterized by purulent discharge and inflammation, with a prevalence of 2-6% in Africa and a notably higher incidence in young children and males. The mainstay of treatment encompasses topical antibiotics, with patient education on hygiene and infection prevention being crucial.

1. A
SEMINAR PRESENTATION
ON
BACTERIAL CONJUCTIVITIS
BY
DR. DANIEL EMEDIONG WALTER
AND
DR GBEREVBIE JOHN-MATHIAS
SUPERVISED
BY
CHIEF DR. ANAVHE MARY
13TH MARCH 2024

2. INTRODUCTION
Conjunctivitis, or pink eye, is an irritation or inflammation of the
conjunctiva (the transparent lubricating mucous membrane which
covers the white part of the eyeball and lining of the undersurface of
the eyelids), caused by allergies or a bacterial or viral infection.
Conjunctivitis can be extremely contagious and is spread by contact with
eye secretions from someone who is infected.

3. ETIOLOGY
Conjunctivitis, which is defined as inflammation of the bulbar and/or palpebral
conjunctiva, has many etiologies, including infection from various bacteria, fungi,
and viruses, as well as toxic and allergic causes.
Bacterial conjunctivitis most often occurs in otherwise healthy individuals. Risk
factors include exposure to infected individuals, fomite, contact lens wear, sinusitis,
immunodeficiency states, prior ocular disease, trauma, and exposure to agents of
sexually transmitted disease at birth.

4. PREVALENCE
• A prevalence between 2% and 6% is reported in various parts of Africa.
• In 2001 it was reported that there was a prevalence rate of 34.7% of MRSA
(Methicillin-resistant Staphylococcus aureus) among S. aureus isolates in Ilorin, in
the North Central part of Nigeria.
• The highest rate of bacterial conjunctivitis was found among infants and children
(0-10 years).
• The rate was also higher in males (59.2%) than in females (40.8%).
• The bacterial etiology often depends on geography and age, but the most
common include Staphylococcus, Streptococcus, Corynebacterium, Haemophilus,
Pseudomonas, and Moraxella species.

5. BACKGROUND
• Bacterial conjunctivitis due to gram-positive bacteria such as Staphylococcus
aureus or Streptococcus pneumoniae is generally milder than conjunctivitis
caused by gram-negative bacteria.
• Gram-negative conjunctivitis is caused by bacteria such as Pseudomonas,
Haemophilus influenzae, Moraxella, C trachomatis, and N gonorrhoeae.
• Gram-negative conjunctivitis is caused by bacteria such as Pseudomonas,
Haemophilus influenzae, Moraxella, C trachomatis, and N gonorrhoeae.

6. PATHOPHYSIOLOGY
• The surface tissues of the eye and the ocular adnexa are colonized by normal
flora such as streptococci, staphylococci, and corynebacteria. Alterations in the
host defense, in the bacterial titer, or in the species of bacteria can lead to clinical
infection.
• The primary defense against infection is the epithelial layer covering the
conjunctiva. Disruption of this barrier can lead to infection.

7. SIGNS AND SYMPTOMS
Symptoms include ; Burning sensation, sensation of grittiness , mild pain or discomfort in the eye.
Signs of bacterial conjunctivitis, beyond injected and edematous (inflamed) conjunctiva, include the
following..
1. Papillae on the injected tarsal conjunctiva, also seen in viral conjunctivitis and ocular allergy.

8. SYMPTOMS CONTD….
2. Discharge: More purulent than in viral conjunctivitis, with more mattering (generally white,
green, or yellow mucous discharge) of the eyelid margins and greater associated difficulty prying
the eyelids open following sleep; patients may report waking up with their eyes “glued” shut.

9. SYMPTOMS CONTD….
3. Enlarged preauricular lymph node: Common in viral conjunctivitis and unusual in bacterial
conjunctivitis, although found in severe bacterial conjunctivitis caused by N gonorrhoeae.

10. SYMPTOMS CONTD….
4. Eyelid edema: Often present in bacterial conjunctivitis, but mild in most cases; severe eyelid
edema in the presence of copious purulent discharge raises the suspicion of N
gonorrhoeae infection.

11. DIAGNOSIS
• Know the differential diagnosis.
• Perform an eye examination and, in particular, document that keratitis, iritis, and acute glaucoma
have been ruled out.
• Always document the best corrected visual acuity in each eye.
• Ascertain the absence of glaucoma on every visit or the inability to safely do so.
• Always consider Chlamydia or N gonorrhoeae in the differential diagnosis. Be sure to treat
systemically and ask for advice from other specialists when needed.

12. DIAGNOSIS CONTD..
Although most routine cases of bacterial conjunctivitis should not require culture confirmation, certain
presentations, such as the following, suggest utility to the astute clinician:
• Neonatal conjunctivitis
• Hyperacute conjunctivitis suggestive of N gonorrhoeae
• Extremely elderly patients
• Immunocompromised patients: HIV infection, chemotherapy, immunosuppressive therapy
• Recurrent or recalcitrant conjunctivitis
• Patients who have undergone recent intraocular surgery: pars plana vitrectomy, cataract, glaucoma shunt.

13. DIAGNOSIS CONTD…
Conjunctival scrapings can also be used in the diagnosis of bacterial conjunctivitis; they can be
collected with topical anesthetic and gentle use of a platinum spatula or similar blunt metallic
object.
• Bacterial infections: Neutrophils predominate
• Viral infections: Lymphocytes predominate
• Allergic reactions: Eosinophils predominate

14. HISTORY TAKING
• A medical and detailed ocular history includes questions about the onset and duration of the red
eye, the quality and quantity of discharge, presence or absence of pain, photophobia, trauma,
blurry vision, foreign body sensation, ocular itch e.t.c
• An eye evaluation should be performed with particular attention to reductions in best corrected
vision in either eye, gross evaluation of lid margins and both bulbar and tarsal conjunctiva any
ocular discharge, pupillary reactions, any pain with eye movements, slit lamp biomicroscope
evaluation of the cornea IOP, and anterior chamber flare or cell.

15. FACTORS TO CONSIDER WHEN TAKING HISTORY
• History of systemic illnesses.
• History of recent exposure to other cases is extremely helpful, especially to children.
• A medication history is important to document what already has been tried and to rule out medicamentosa
• A history of allergies to medications.
• Contact lens wear, especially extended-wear contact lens use.
• Duration of the disease and previous attempts at therapy should be documented.
• Compliance to antibiotic use can also help determine whether antibiotic resistant bacteria may be involved.
• Venereal diseases should be considered in patients at a sexually active age

16. PROGNOSIS
• The prognosis for complete recovery without sequelae is excellent in bacterial conjunctivitis, as long as the
cornea is not involved. Most benign cases are treated with topical antibiotics or self-resolve. Complications
are expected to develop only in cases caused by extremely pathogenic bacteria, such as C 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. Chlamydial
infection in the newborn can lead to pneumonia and/or otitis media.

17. COMPLICATIONS
• Bacterial conjunctivitis, as long as the cornea is not affected, seldom leads to complications.
• General concerns include membrane formation, severe post recovery dry eye, and subsequent
scarring of the punctum; corneal ulcer when the epithelium is not intact; and symblepharon from
severe inflammation.

18. DIFFERENTIAL DIAGNOSIS OF BACTERIAL CONJUCTIVITIS

20. MANAGEMENT
• The mainstay of treatment for bacterial conjunctivitis is topical (administered as eye drops or
ointment) antibiotic therapy. Systemic antibiotics are indicated for gonorrhea and chlamydial
infections. Under certain circumstances, topical antibiotics may be considered of limited benefit
and, considering the risks of widespread antibiotic resistance, should be withheld while the
disease course resolves without treatment.
• Steroid use is controversial.

21. TOPICAL ANTIBIOTIC THERAPY
• For mild and non–vision-threatening bacterial conjunctivitis, older-generation antibiotics should
be used. Later-generation antibiotics and the latest fluoroquinolones should be reserved for more
serious infections to minimize the risk of developing microbial resistance. The following are older
topical antibiotics that remain efficacious:
• Trimethoprim with polymyxin B, Azithromycin. Gentamicin, Tobramycin, Neomycin, Ciprofloxacin,
Ofloxacin, Gatifloxacin, Erythromycin, Bacitracin.

22. TOPICAL ANTIBIOTIC THERAPY
• For moderate and severe bacterial conjunctivitis, the latest fluoroquinolones, including
moxifloxacin, besifloxacin, and levofloxacin, are generally effective.
• Rare severe infections may also require patient hospitalization to ensure consistent
administration of fortified aminoglycoside-cephalosporin combination therapy, fortified topical
vancomycin, or topical fluoroquinolone monotherapy treatment every 15 minutes to hourly.

23. TOPICAL ANTIBIOTIC THERAPY
• Regardless of the topical antibiotic regimen chosen, start off with a higher frequency of dosing
(e.g, q2h) for the first 1-2 days before decreasing the dosage (e.g, qid) for the subsequent 5-7
days.
• Neonatal chlamydial infection is treated with oral erythromycin. Doxycycline is used to treat the
mother of a neonate with chlamydial infection as well as her at-risk contacts.
• Intravenous penicillin G is used for neonatal gonorrhea infections. Third-generation
cephalosporins are used in the treatment of adult gonorrhea infections.

24. SYSTEMIC MEDICATIONS
• Azithromycin (zithomax, zmax)
• Doxycycline.
• Erythromycin base.
• Levofloxacin.
• Cetriazone

25. PREVENTION
• To prevent bacterial conjunctivitis, patient education should include good hygiene and avoidance
of touching the eyes, especially after exposure to potentially infectious sources.
• Proper contact lens care includes avoidance of contact lens wear while sleeping and proper
cleaning and discarding of both lenses and contact lens cases.
• Patients with bacterial conjunctivitis should be instructed not to touch their eyes and to avoid
sharing fomites. They should also be educated regarding their infectious nature to prevent
transmission and the importance of finishing their antibiotic regimen.
• Patients with bacterial conjunctivitis who wear contact lenses should be instructed to
discontinue contact lens use and to discard their used contact lenses, open contact lens solutions,
used contact lens cases, and used makeup and makeup brushes.