H44
DESCRIPTION
Intensely painful eye infection characterised by red eye with or without a discharge (excluding simple or non-painful conjunctivitis).
Assess clinically for:
- Herpes conjunctivitis indicated by vesicles on skin next to eye
- Loss of vision
- Irregularity of pupil
- Haziness of the cornea
Investigations
Swab eye for microbiological culture.
GENERAL AND SUPPORTIVE MEASURES
Patient education on personal hygiene to avoid spread. Educate patient on correct application of ophthalmic drops.
Advise patient:
- to wash hands thoroughly before applying ophthalmic ointment,
- not to share ophthalmic ointments or drops,
- not to rub eyes, and
- never to use urine or milk to wash the eyes.
MEDICINE TREATMENT
If herpes infection suspected, treat as outlined in: Herpes keratitis and conjunctivitis . If bacterial cause demonstrated or suspected:
During the day:
- Gentamicin, ophthalmic drops, instill 1 drop 4–6 hourly.
OR - Chloramphenicol 0.5%, ophthalmic drops, instill 1 drop 4–6 hourly.
AND
Apply at night:
- Chloramphenicol 1%, ophthalmic ointment.
REFERRAL
To ophthalmologist within 24 hours if associated with any of the following:
- Reduced vision.
- A cloudy cornea.
- A corneal opacity or a staining corneal ulcer.
- Pus and blood level in the anterior chamber (hypopion and hyphaema).
- Cloudiness in the anterior chamber (poor view of iris details.
- An irregular or dilated (including partially dilated) pupil.
- A cloudy or poor view of the retina.
- A poor or greyish red reflex.
- Proptosis.
- Restricted ocular movements.
- Severe ocular pain.
Non-urgent referral
- A unilateral red eye for more than one day.
- No improvement after 5 days of treatment.