Bacterial Conjunctivitis

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  • Redness, foreign body sensation, purulent, whitish-yellowish secretion; itching not typical
  • Children more often affected by bacterial conjunctivitis than adults (more often viral in adults)
  • CAVE:
    • hyperacute onset (<24h) and massive secretion DD gonococcal conjunctivitis, see below
    • In chronic conjunctivitis, DD chlamydial conjunctivitis, see below


  • Lacrycon gtt (or other lubricating drops) several times daily, since it is often self-limiting
    • Alternatively Tobrex gtt (Tobramycin) 3x/d for 5-7 days or Floxal gtt (Ofloxacin) 3x/d and Floxal ointment before sleeping for 5-7 days

Gonococcal Conjunctivitis


  • Hyperacute (<24h) massive purulent secretion
  • might have haemorrhages, chemosis
  • might have punctate, superficial corneal defects, corneal stromal infiltrates, ulcers, abscesses, perforations, opacities, anterior chamber cells / flare, hypopyon, endophthalmitis, eyelid erythema, oedema


  • Conjunctival smear (with Gram staining)


  • Vigamox gtt 3x/d for 7-10 days or longer, depending on findings
  • Ceftriaxone 1x 1g i.m. or 1g Ceftriaxone i.v. in case of corneal involvement
  • in case of resistant (or if resistance is suspected) N. gonorrhoeae strain:
    • additionally a single dose of azithromycin 1g per os
  • CAVE: Partner therapy! + Screening for other STDs: HIV, Hep. C, Syphilis, Chlamydia, etc.

Chlamydia conjunctivitis


  • Watery or mucopurulent secretion, large follicles
  • Often keratitis punctata superficialis, sometimes subepithelial corneal infiltrates (nummuli) 2-3 weeks after onset
  • Preauricular lymphadenopathy
  • usually symptoms for weeks to months -> in case of chronic conjunctivitis: think of chlamydia!


  • Conjunctival smear (scraping of the tarsal conjunctiva (until it bleeds, intracellular pathogens))


  • Vigamox gtt 3x/d for 7-10 days
  • Doxycycline 2x100mg daily p.o. for 1 week; alternatively azithromycin 1x 1g p.o. (single shot)
  • CAVE: Partner therapy! + Screening for other STDs: HIV, Hep C, Syphilis, Chlamydia, etc.


  • EyeWiki Bacterial Conjunctivitis
  • AWMF Leitlinie zu Infektionen mit Chlamydia trachomatis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)