Home' Australian Pharmacist : Australian Pharmacist September 2014 Contents Australian Pharmacist September 2014 I © Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
EVIDENCE IN PATIENT CARE
Mr JB presents to the pharmacy complaining of red eyes, which feel
irritated and have a discharge, with some ‘gluing’ of the eyelids in the
morning. He has had this for almost two days and his vision is not
affected. Mr JB’s young son, who attends a local day care centre, had the
same symptoms a few days ago, but it seemed to resolve quickly.
Conjunctivitis is the most common
cause of presentations for ‘red eye.’
Conjunctivitis refers to inflammation
of the conjunctiva and is characterised
by ocular redness, irritation, itching
and discharge. It is the most
common ophthalmic problem in
the developed world, and accounts
for an estimated 1–2% of all general
practice consultations in Australia.
The majority of patients with acute
conjunctivitis present to primary
care for management. Conjunctivitis
has a surprisingly high social and
economic footprint – the costs of
treating bacterial conjunctivitis alone
in the US were recently estimated to
be between $377 and $857 million per
annum.3 This article focuses on infective
conjunctivitis and its management in
the primary care setting.
Viruses and bacteria are the most
common causes of infectious
conjunctivitis. Other causes include
allergy, irritants, toxicity, as well as
inflammation due to immune-mediated
diseases and neoplastic processes.
Overall, viral conjunctivitis is the
most common cause of infective
conjunctivitis. In children, bacterial
conjunctivitis is more common,
and is responsible for 50–75% of all
Allergic conjunctivitis affects
approximately 40% of the population,
but only around 10% of people affected
seek care, leaving the vast majority of
sufferers undiagnosed.5 Ninety per cent
of allergic conjunctivitis is seasonal.
Conjunctivitis can be classified as acute,
hyperacute or chronic according to
onset and severity, and may be primary
BY ASSOCIATE PROFESSOR LUKE BEREZNICKI
Associate Professor Luke Bereznicki is Associate Head
of Pharmacy and Deputy Head of School at the
School of Medicine, University of Tasmania.
After reading this article, pharmacists should be
• Discuss the features and causes of infective
• Describe the signs and symptoms of infective
• Outline approaches to the management of
infective conjunctivitis, including the rational use
of topical antibiotics.
Competency standards (2010) addressed: 1.3,
4.2, 7.1 .
Accreditation number: CAP140909E
or secondary due to systemic diseases
such as chlamydia, gonorrhoea, which
may require systemic treatment.
Viral conjunctivitis is commonly caused
by adenoviruses (65–90% of cases).
highly contagious, usually spread through
direct contact with contaminated fingers
or swimming pool water. Often, viral
conjunctivitis is associated with upper
respiratory tract infections. It is usually
mild, and resolves after 1–2 weeks.
Other causes of viral conjunctivitis, such
as herpes simplex virus (HSV), are less
common and less likely to spread.
Bacterial conjunctivitis is highly
contagious, and like viral conjunctivitis,
spread through direct contact with
contaminated fingers. In primary care,
the acute form of bacterial conjunctivitis
is most common, usually caused by
Staphylococcus aureus in adults, or
Streptococcus pneumonia or Haemophilus
influenzae in children. Symptoms usually
resolve in 7–10 days. Hyper acute
bacterial conjunctivitis, often caused by
Neisseria gonorrhoeae, is characterised by
large amounts of purulent discharge, pain
and diminished vision – prompt referral is
required. Chronic bacterial conjunctivitis
is characterised by intermittent symptoms
that persist for more than four weeks.
Red eye has a range of causes, and
pharmacists would be well aware of the
need for appropriate history taking to
rule out potentially sight-threatening
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