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Conjunctivitis - infective - Management
How do I determine the cause of infective conjunctivitis that persists longer than 2 weeks?
If suspected infective conjunctivitis persists for longer than 2 weeks:
- Reassess the diagnosis — see Diagnosing infective conjunctivitis.
- Assess features suggestive of blepharitis and see the CKS topic on Blepharitis if they are present. Features include:
- Swollen eyelids: the defining sign of staphylococcal blepharitis, but unusual when it is less severe.
- Inflamed lid margins: usually present.
- Altered eyelash appearance: including misdirection, crusting, and eyelash loss.
- Altered eyelid surfaces: may be scaly, oily, or greasy. Ulceration of the anterior lid indicates infection.
- Take swabs for bacteria and chlamydia.
- Consider prescribing a topical ocular antibiotic while awaiting results of swabs.
Basis for recommendation
Basis for taking swabs to identify the pathogen causing infective conjunctivitis lasting longer than 2 weeks:
- Microbiological investigations are not considered necessary in primary care when a person presents with a short history of infective conjunctivitis because most cases will settle spontaneously. However, management of chronic infections requires microbiological identification of the causative organism.
- The recommendation to swab people with infective conjunctivitis that persists for longer than 2 weeks is pragmatic and based upon the established pathophysiology of infective causes of conjunctivitis published in authoritative texts [Yanoff and Duker, 2004].
- Most bacterial and viral infections resolve spontaneously within 2 weeks.
- Chlamydial infections, and some bacterial infections, can cause chronic conjunctivitis lasting for weeks or months if untreated.
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