INFECTIOUS DISEASE REVIEW Upper Respiratory Tract Infections

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. Allergic Conjunctivitis Courtesy of http://www.aaaai.org Figure 2-Viral Conjunctivitis-note diffuse redness in both eyes with NO matting Viral Conjunctivitis Picture courtesy of www.eyedrops.info Figure 3- Bacterial Conjunctivitis-Note matting of both eyes 12
Bacterial Conjunctivitis picture courtesy of www.eyedrops.info ASSESSMENT Consider patient referral to an ophthalmologist or to the emergency room. You may want to check the patient for photophobia (i.e., cannot look at light source without squinting/closing eyes) and for any irregularity of image reflection on the surface of the cornea. A fluorescent light fixture is a good source of a "rectangular" light image that you can have the patient look at and observe the reflection of the shape of the light. If either abnormality is present, get the patient to an ophthalmologist quickly. Call for an appointment STAT while the patient is with you. 1. In dry eyes WITHOUT INFECTION or corneal damage, artificial tears are good for long-term use to decrease the frequency of eye infections and allergic response. Drugs that are anticholinergic in primary or side effects may worsen dry eye conditions, e.g., antihistamines and anticholinergics for incontinence, such as cetirizine or oxybutinin. Make sure that a polymer is part of the formulation, e.g. methylcellulose, or PVP to prolong contact of the drop with the surface of the eye. Examples are: Adsorbatear, Liquifilm, Tearisol, etc. Dose is 2gtts in each eye QID CONTINUOUS. NOTE: The regular instillation of artificial tears with this regimen has been shown to reduce the frequency of bacterial conjunctivitis (JW Cooper, Cons Pharm l988; 3:83.). The use of topical cyclosporine (Restasis) emulsion for chronic dry eyes is much more expensive and may NOT work if topical NSAIDs or corticosteroids are in use. Topical Cyclosporine drops (Restasis) should NOT be used in active eye infections. The need for an antibiotic eye preparation more often than quarterly to semi-annually with change of seasons suggests the need for regular use of artificial tears. Visual inspection of the eyes that finds apparent dryness for more than several days at a time, also raises the question of need for continual usage of an artificial tear/polymer preparation. BE SURE TO APPLY artificial tears LAST or at least 30-60 minutes away from glaucoma topical eye preparations to prevent occlusion of the eye absorbing surface by the polymer in the artificial tears. 2. For allergic, itchy eyes, artificial tears with a topical vasoconstrictor is preferable, e.g. Visine. In addition, the younger patient may need diphenhydramine 25mg HS or chlorpheniramine maleate (CTM) 2mg once to BID to TID for allergy; a non-sedating antihistamine such as loratidine (Claritin/Alavert) 10mg daily may be preferable in older patients or those who cannot tolerate the sedation, INCREASED FALL RISK and drying side effects of the 13
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INFECTIOUS DISEASE REVIEW Upper Respiratory Tract Infections

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