Management of Conjunctivitis in General Practice

This chapter will describe various treatment options for infective conjunctivitis, allergic conjunctivitis, conjunctivitis in immunological disorders and other varieties of conjunctivitis that can be effectively managed in general practice whilst also highlighting various RCTs and systematic reviews on treatment of conjunctivitis. The conjunctiva is a vascularised mucus membrane that covers some anterior portion of the globe and the inner aspects of eye lids. Like all mucous membranes, it also consists of epithelial and stromal layers. The continuum of the epithelial cell layer occurs in one side with epidermis of the lids at the lid margin and with the corneal epithelium at the limbus. Because of this anatomical architecture we call this pouch as conjuctival cul-de sac. The conjunctiva has enormous potential for combating infections mainly because of a) high vascularity b) different types of cells present in conjunctiva initiating and participating in defence inflammatory reactions c) immunopotent cells present in conjunctiva d) enzymatic activity of conjunctiva neutralising many pathogens including viruses. However the conjunctival sac is rarely sterile and is prone to external insult as well as victim of immunological reactions. It has been found that the normal conjunctival flora shares organisms with the skin and respiratory tract. The major organisms found are Staphylococcus, Diptheroids, Anaerobes, Streptococcus, Pneumococcus, Hemophilus, E.Coli etc. However, as most of these potential pathogens are in their dormant stage, they rarely cause infection. Bacterial or infective conjunctivitis is mainly due to organisms of exogenous source. Though many forms of such infections are self-limiting because of barrier function of the conjunctival epithelium, there are exceptions for certain virulent organisms such as N.gonorrhea, Listeria monocytogens ,Corynobacterium diptheriae and the Haemophilus group. These bacteria possess proteolyitic enzymes which damage the parenchymal structure of the conjunctiva. Some conjunctival infections may signify an underlying disease something more sinister such as a systemic disease. In neonates, infective conjunctivitis poses a greater