***diagnosis
1-red eye + muco purulent discharge + sticky eyelashes in morning
"احمرار بالعين +إفرازات صديدية +الرموش بتبقى لازقة في بعضها الصبح
2-usually start unilateral &spread to other eye within 2-5day
غالبا بتبقى في عين واحدة ثم تنتقل للعين الثانية في خلال أيام
3-no enlarged preauricular LN
لا يوجد تضخم في العدد الليمفاوية أمام الأذن
4-mild itching May be present
ممكن يبقى في هرش بسيط
5-some other symptoms may be present
بعض الأعراض الأخرى قد يشتكي منها المريض بس مش في كل الحالات
*conjutival injection or chemosis
احمرار شديد
*foreign body sensation
حاسس ان في حاجة في عينه
*lid edema
تورم بسيط في الجفون
***treatment... العلاج...
1-instructions... تعليمات هامة...
-عدم استخدام فوطة شخص آخر
- عدم استعمال العدسات اللاصقة طوال فترة العلاج
2-warm compresses
كمادات مياه دافئة
3-pure antibiotic eye drops &ointment
a-antibiotic eye drops
*tobrex E.D
-contains "tobramycin"
-الأفضل والأكثر أمانا في الأطفال
*fucithalmic E.D
-contains "fusidic acid"
-قوامها قريب للمرهم عشان كده اسمها
"viscous eye drop "
*isomiphenicol E.D
-contains "chloramphenicol"
-أرخص مجموعة ولكن لا تستخدم في الأطفال والحوامل ويجب حفظها في الثلاجة
*vigamox E.D
-contains "moxifloxacin"
اغلاهم على الإطلاق
*levoxin E.D
-contains "levofloxacin"
*oflox E.D
-contains "ofloxacin"
ممكن نستخدم أي نوع فيهم 4مرات يوميا لمدة أسبوع
b-eye ointment.. مرهم عين...
*tobrex or terramycin oint
دهان قبل النوم لمدة أسبوع
4-systemic antibiotic
ممكن تزود أقراص مضاد حيوي على حسب شدة الحالة
-hibiotic 1gm contains
"amoxicillin +clavulinic acid"
قرص كل 12 ساعة لمدة اسبوع
*medical background
Bacterial conjunctivitides generally last 1-2 weeks and are usually self-limiting.
-The mainstay of treatment for bacterial conjunctivitis is topical antibiotic therapy, with the intent of significantly reducing the duration of symptoms and likelihood of contagion.
-Ideally, the antibiotic should be specific for the causative organism. Unfortunately, bacterial culturing, although recommended, is not always available nor cost-effective for routine cases, and Gram stain may take several days to yield results.
-For mild and non–vision-threatening bacterial conjunctivitis, older-generation antibiotics should be used.
- Later-generation antibiotics should be reserved for more serious infections to minimize creation of bacterial resistance in the ocular surface flora.
- For moderate to severe bacterial conjunctivitis, the latest-generation fluoroquinolones provide excellent gram-negative and some gram-positive bacterial coverage.
-Fortified antibiotics are also used in severe cases.
-Systemic antibiotics are indicated for N gonorrhoeae and chlamydial infections. Surgical intervention is required only when indicated for the treatment of causative conditions, such as hordeolum, nasolacrimal duct obstruction, or sinusitis.
*Steroid use in combination with antibiotics is controversial, and results are mixed in terms of decreasing corneal scarring.
-Unfortunately, steroids may slow the rate of healing, increase the risk of corneal melting, and increase the risk of elevated IOP.
-Povidone-iodine solution 1.25% ophthalmic solution may be a safe and viable alternative to topical antibiotics for treating bacterial conjunctivitis, especially in resource-poor countries, where antibiotics may be hard to come by and/or expensive.
-Inpatient care for bacterial conjunctivitis is highly unusual and would be provided only if hospitalization is indicated for other reasons or if antibiotic treatment is required every 15 minutes around the clock (severe cases).
- It is important to realize that, in the inpatient setting, the differential diagnoses must be carefully considered through internal medicine consultation since these patients tend to be ill. Therefore, it is more common to see a red eye due to endogenous endophthalmitis, hyperacute gonorrheal conjunctivitis, orbital cellulitis, or a perforated corneal ulcer in this population.
-Serious consideration should be given to admitting patients with hyperacute bacterial conjunctivitis if the entire cornea cannot be visualized, as there may be an early peripheral corneal ulceration threatening perforation, especially in Neisseria infections.
-Topical antibiotic, proper hygiene, and isolation are considerations for these patients.
Be aware of drug alerts, such as the Fusariumkeratitis outbreak related to ReNu with MoistureLoc (Bausch & Lomb) in 2006 and the Acanthamoeba keratitis outbreak in 2003-2006 related to Complete Moisture Plus (AMO).
-Also of special concern is trachoma, a devastating disease characterized by chronic infection during youth and potentially blinding corneal and conjunctival scarring in mid-life.
-Although acute hospitalization is uncommon for trachoma, hospital-based preventive lid surgeries are central to trachoma management paradigms. See Trachoma.
-Instruct patients to return for follow-up if they do not recover completely in a timely manner, so that therapy can be reassessed. Consider culture and conjunctival scrapings for resistant cases.
posted from Bloggeroid
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