Assessment of the eye infections

By Kiran Gupta

Patients with ophthalmic conditions commonly present to the pharmacist for consultation. Many symptoms related to the eye are minor and can be managed through general self-care.
The potential risk to vision that is inherent with eye complaints, however, requires that a pharmacist understand the most common disorders of the eye as well as the signs and symptoms that require referral to a primary care provider or an emergency room.
Conjunctivitis and glaucoma are only two of the many ophthalmic conditions that pharmacists will encounter in their practice, but they are among the most common.

Conjunctivitis refers to any inflammation of the clear mucous membrane of the eye and can be divided in two groups: infectious (bacterial, viral, chlamydial and gonococcal) and non-infectious (allergic, dry eye, toxic, contact lens use, neoplasm, foreign body, factitious and idiopathic).
Viral conjunctivitis, most commonly caused by an adenovirus, is probably the most common form and is usually preceded by a recent cold, sore throat, or exposure to someone with the condition. Individuals suffering from viral conjunctivitis often have a “pink eye,” with either a watery or in some cases, an exudative discharge.
Viral conjunctivitis is usually self-limiting, with symptoms resolving over 1 to 3 weeks. Treatment is aimed at symptomatic relief using artificial tear preparations and ocular decongestants. Certain forms of viral conjunctivitis are very contagious; therefore, hand washing, not sharing towels, and proper disposal of tissues should be reinforced.

Bacterial conjunctivitis is commonly caused by Staphylococcus aureus, S. Epidermidis, Streptococcus Pneumonia, or Haemophilus influenza. This condition is characterized by a red eye with a purulent discharge.
Chlamydial conjunctivitis may have many signs and symptoms in common with both viral and bacterial conjunctivitis and is often misdiagnosed. Infection with Neisseria sp. should be ruled out when severe, bilateral, purulent conjunctivitis is present in a neonate 3 to 5 days postpartum. Both chlamydial and gonococcal conjunctivitis require aggressive antibiotic therapy, but conjunctivitis caused by other bacteria is usually self-limiting within 2 weeks.

A non-infectious cause of conjunctivitis is an allergic reaction. Allergic conjunctivitis is characterized by a red eye with a watery discharge. In fact, the hallmark symptom of this condition is copious, clear, watery discharge. Severe forms of allergic conjunctivitis may present with a clear, gel-like form of discharge. Itching is also a common symptom.
Allergic conjunctivitis may result from seasonal exposure to allergens such pollen or from perennial exposure to allergens such as pollen or from perennial exposure to items such as animal dander. A personal or family history of atopic disease is common in patients suffering from allergic conjunctivitis. Allergic conjunctivitis is generally treated with topical antihistamines, mast cell stabilizers or anti-inflammatory agents.
Chemical or toxic conjunctivitis can result from an accidental splash of a chemical to the eye.

For any form of conjunctivitis, the primary presenting symptom is a "red eye".