Antibiotic Treatment and Health Care Use in Children and Adolescents With Conjunctivitis.

This cohort study examines ambulatory care revisits and same-day topical antibiotic prescription in insured patients with acute infectious conjunctivitis.

The Effect of Ophthalmic Antibiotics on Clinical Outcomes and Transmissibility of Conjunctivitis Associated with Haemophilus influenzae versus Other Pathogens: Secondary Analysis of a Randomized Controlled Trial.

Transmission rates among children with conjunctivitis were low and antibiotic use was not associated with reduced transmission. Policies recommending exclusion from daycare and school for conjunctivitis should be scrutinized as they may not reduce transmission and may increase unnecessary antibiotic use.

Cost-Effectiveness of Pediatric Conjunctivitis Management and Return to Childcare and School Strategies: A Comparative Study.

BACKGROUND: Infectious conjunctivitis affects 1 in 8 children annually, resulting in high ophthalmic antibiotic prescribing and absenteeism from childcare and school. We aimed to quantify the cost-effectiveness and annual savings of 3 evidence-based approaches to conjunctivitis management and return to childcare and school compared to usual care. METHODS: Using a decision analytic model from a societal perspective over a 1-year time horizon, we conducted a cost-effectiveness analysis of 3 management strategies for children aged 6 months to 17 years with non-severe conjunctivitis compared to usual care in the United States. Strategies accounted for rate of transmission. Strategies included (1) refraining from prescribing ophthalmic antibiotics for non-severe conjunctivitis, (2) allowing children without systemic symptoms to attend childcare and school, (3) and the combined approach of refraining from prescribing ophthalmic antibiotics and allowing children without systemic symptoms to attend childcare and school. RESULTS: The estimated annual expenditure for pediatric conjunctivitis was $1.95 billion. Usual care was the most expensive ($212.73/episode), followed by refraining from ophthalmic antibiotic prescribing ($199.92) and allowing children without systemic symptoms to attend childcare and school ($140.18). The combined approach was the least costly ($127.38). Disutility was similar between approaches (quality-adjusted life days 0.271 vs 0.274). Refraining from antibiotic prescribing and the combination approach were dominant compared to usual care. The combined approach resulted in an estimated $783 million annual savings and 1.6 million ophthalmic antibiotic courses averted. CONCLUSIONS: Conjunctivitis poses an economic burden that could be reduced by refraining from ophthalmic antibiotic use and allowing children without systemic symptoms to remain at school or childcare.

Ligneous conjunctivitis: Fresh-frozen plasma and heparin use intra-and postoperatively, a report of two cases.

Ligneous conjunctivitis is a rare chronic form of recurrent membranous inflammation and plasminogen deficiency. Ocular manifestations may be associated with sites other than mucous membranes, such as the oral cavity, internal ear, respiratory, genitals, and kidney. Treatment is extremely difficult because of the lack of topic plasminogen drops, and a high volume is required for systemic supplementation. This report aimed to present two patients with ligneous conjunctivitis treated with membrane excision, topical fresh-frozen plasma, and heparin intra-, and postoperatively. No recurrence was found in the ligneous membrane in the 12-month follow-up. The use of topical fresh-frozen plasma and heparin after membrane excision could be effective to avoid recurrence.

Tumor-like lymphoplasmacytic conjunctivitis in the third eyelid in a dog.

This report aims to describe a case of tumor-like lymphoplasmacytic conjunctivitis in a 7-year-old spayed-female Pomeranian. On complete ophthalmic examination, a mass with papillary projections was noted on the bulbar surface of the right third eyelid. Debulking of the mass was performed while preserving as much of the third eyelid as possible. On the histopathological examination, the mass was diagnosed as lymphoplasmacytic conjunctivitis with mild epithelial hyperplasia. Although a slight regrowth of the mass was noted 3 weeks after surgery, intralesional injection of triamcinolone acetonide led to its disappearance. There was no further recurrence after 5 months.

Los colirios antibióticos acortan la duración de las conjuntivitis infecciosas en niños / Antibiotic eye drops shorten the duration of infectious conjunctivitis in children

Conclusiones de los autores del estudio: el tratamiento de la conjuntivitis infecciosa aguda en niños con antibióticos tópicos se asoció con una duración significativamente menor de la sintomatología conjuntival. Comentario de los revisores: el uso de antibiótico tópico, aunque de forma modesta, beneficia al paciente, acortando la curación clínica en las conjuntivitis agudas. No obstante, dado el curso autolimitado de esta patología y la falta de estudios de coste-efectividad en este ámbito, no parece justificada su indicación generalizada desde Atención Primaria. Se necesitarían realizar dichos estudios para evaluar el impacto global en la sociedad del tratamiento en estos pacientes. (AU)

Authors´ conclusions: topical antibiotics were associated with significantly shorter durations of conjunctival symptoms in children with acute infective conjunctivitis. Reviewers´ commentary: the use of topical antibiotics modestly benefits the patient, shortening the clinical cure in acute conjunctivitis. However, given the self-limited course of this pathology and the lack of cost-effectiveness studies in this area, its generalized prescription in primary care does not seem justified. Such studies should be carried out to assess the overall impact on society of the treatment of these patients. (AU)

Design and evaluation of ocular hydrogel containing combination of ofloxacin and dexamethasone for the treatment of conjunctivitis

Abstract Conjunctivitis is an inflammation of the conjunctiva, which covers the white part of the eyeball. It can be caused by allergies, bacterial or viral infection. In situ hydrogels are three-dimensional hydrophilic cross-linked network of polymers. In situ hydrogel provided better therapeutic index when compared to conventional treatment. The present work describes the formulation and evaluation of ofloxacin and dexamethasone based on the concept of pH triggered in situ gelation. Carbopol 934p was used as the gelling agent in combination with HPMC, as a viscosity-enhancing agent, benzalkonium chloride as preservative, sodium chloride as tonicity adjusting agent. The prepared formulations were liquid at the low pH and underwent rapid transition into viscous gel at the pH of the tear fluid. Formulations were evaluated for various rheological, in vitro and in vivo release characteristics. Infrared spectroscopy studies showed that there were no interactions between the drug and polymers. Viscosity of the prepared hydrogels lies in the optimum range and drug was released up to 85 % as the end of 13 h. The prepared in situ hydrogel was sterile, non-irritant to the eye. The present study indicated that it is possible to develop safe and physiologically effective in situ hydrogel which is patient compliant.

Surto de conjuntivite aguda no período de 2017-2018 em Recife, Brasil / Outbreak of acute conjunctivitis in the period 2017-2018 in Recife, Brazil

RESUMO Objetivo: Avaliar o perfil clínico, epidemiológico e o impacto econômico do surto de conjuntivite no período 2017-2018 no município de Recife-PE. Métodos: Estudo transversal com base na análise de prontuários de pacientes com diagnóstico de conjuntivite, atendidos na emergência da Fundação Altino Ventura entre dezembro/2017 e março/2018. Os dados coletados incluíram manifestações oculares no exame, complicações subsequentes, manejo e dias de licença médica. Resultados: Dos 12.712 pacientes atendidos na FAV entre dezembro de 2017 e março de 2018, 6.359 (50,0%) foram diagnosticados com conjuntivite, dos quais 3.543 pacientes (55,7%) foram atendimentos únicos. A média de idade dos pacientes ao atendimento foi de 29,5 ± 14,1 anos (variação, 1-85 anos), com distribuição semelhante entre os sexos (2.288 casos [50,1%] masculino; 2.282 casos [49,9%] feminino). O diagnóstico mais comum foi conjuntivite sem pseudomembrana (5.645 casos [88,8%]). Hiperemia conjuntival (6.278 casos [98,7%]) e reação folicular (6.255 casos [98,4%]) foram os achados mais frequentes ao exame. A complicação mais frequente foi pseudomembrana (1.062 casos [16,7%]). Os colírios lubrificantes (4.308 [67,7%]) e os colírios de associação antibiótico com corticoide (2.033 [32%]) foram os mais prescritos no tratamento. A média de dias de atestado médico foi de 4,8 ± 2,9 dias (variação, 1- 47 dias) e a perda de produtividade estimada em R$1.159.329,14. Conclusão: O surto de conjuntivite em Pernambuco foi responsável por metade das consultas em um pronto-socorro oftalmológico. Surtos de conjuntivite podem causar um impacto econômico, uma vez que afeta principalmente adultos jovens em idade produtiva. As características clínicas observadas sugerem um surto de conjuntivite de etiologia viral.

Abstract Purpose: To evaluate the epidemiological and clinical profile and economic impact of the acute conjunctivitis outbreak in the period of 2017-2018 in Recife-PE. Methods: Cross-sectional study based on the analysis of medical records of patients diagnosed with conjunctivitis at the emergency room of the Altino Ventura Foundation (FAV) between December 2017 and March 2018. The collected data included ocular manifestations at examination, subsequent complications, management, and days of sick leave. Results: Out of 12,712 patients assisted at FAV from December 2017 to March 2018, 6,359 (50.0%) were diagnosed with conjunctivitis. The mean age of patients was 29.5 ± 14.1 years (range, 01-85 years), with similar distribution between sex (2,288 50.1% male; 2,282 49.9% female). The most common diagnosis was non-pseudomembranous conjunctivitis (5,645 cases 88.8%). Conjunctival hyperemia (6,278 cases 98.7%) and follicular reaction (6,255 cases 98.4%) were the most frequent ocular findings. The most common complication was pseudomembrane in 1,062 cases (16.7%). Lubricants (4,308 67.7%) and antibiotic associated to corticosteroid eyedrops (2,033 32.0%) were the most prescribed medications. The average days of sick leave per patient was 4.8 ± 2.9 days (range, 1- 47 days) and the productivity loss estimated in R$1.159.329,14. Conclusion: The conjunctivitis outbreak in Pernambuco, Brazil was responsible for half of the consultations in an ophthalmic emergency room. Conjunctivitis outbreaks may cause an economic impact as it mostly affects young adults in their productive ages and take in average a 5-day sick leave. The clinical characteristics observed suggest an outbreak of conjunctivitis of viral etiology.

Conjuntivite e COVID-19 / Conjunctivitis and COVID-19

RESUMO Apresentamos um caso de conjuntivite por SARS-CoV-2 em mulher de 55 anos, com hiperemia e sensação de corpo estranho em ambos os olhos. O exame oftalmológico revelou conjuntivite. A paciente apresentou reação em cadeia da polimerase de SARS-CoV-2 detectável em swab conjuntival e nasal. O tratamento foi realizado com colírio de ciprofloxacina, corticoide e trometamol por 5 dias. Após o sétimo dia de evolução, houve melhora importante da conjuntivite, e foi repetido swab conjuntival, com resultado não detectável.

ABSTRACT We present a case of SARS-CoV-2 conjunctivitis in a 55-year-old female patient, with hyperemia and foreign body sensation in both eyes. The eye examination revealed conjunctivitis. She had detectable SARS-CoV-2 by polymerase chain reaction on conjunctival and nasal swabs. She was treated with ciprofloxacin eye drops, corticosteroids and trometamol for 5 days. After the seventh day of evolution, there was a significant improvement in conjunctivitis, and repeated conjunctival swab was negative.

Tratamiento con ciclosporina al 0.1% (Ikervis(R)) en conjuntivitis corticodependiente asociada a dupilumab / Cyclosporine 0.1% (Ikervis(R)) treatment in steroid-dependent dupilumab-associated conjunctivitis

El dupilumab es un fármaco de reciente aprobación por la Food and Drug Administration (FDA) y la European Medical Agency (EMA) para el tratamiento de la dermatitis atópica moderada-severa en adultos. El incremento de la frecuencia de conjuntivitis asociadas a dupilumab ha sido expuesto en publicaciones y ensayos recientes. Presentamos 2 casos de conjuntivitis corticodependiente tratados satisfactoriamente con ciclosporina al 0,1% (Ikervis(R)). No hay casos previos descritos de conjuntivitis asociada a dupilumab tratados con ciclosporina al 0,1% (Ikervis(R))

Dupilumab is a drug that has recently been approved by the Food and Drug Administration (FDA) and European Medical Agency (EMA) for the treatment of moderate-to-severe atopic dermatitis in adults. An increase in frequency of conjunctivitis related to dupilumab treatment has been reported in recent publications and clinical trials. We report two steroid-dependent cases satisfactorily treated with cyclosporine 0.1% (Ikervis(R)). To our knowledge there are no reported cases of dupilumab-associated conjunctivitis treated with cyclosporine 0.1% (Ikervis(R)

Conjuntivitis cicatrizal recalcitrante: Tratamiento de nueve pacientes con rituximab / Recalcitrant cicatrizing conjunctivitis. Treatment of nine patients with rituximab

La conjuntivitis cicatrizal es la consecuencia de distintas enfermedades oculares. Entre ellas, las más graves son el penfigoide cicatrizal y el síndrome de Stevens-Johnson crónico. El tratamiento de estas enfermedades con corticoides e inmunosupresores es habitualmente exitoso, pero unos pocos pacientes siguen un curso recalcitrante. En los últimos años se introdujo el uso de rituximab, asociado o no a gammaglobulina endovenosa, en forma abierta, para el control de la inflamación conjuntival. Describimos aquí el tratamiento de siete pacientes con penfigoide y dos con Stevens-Johnson recalcitrante, con rituximab. Ocho recibieron también gammaglobulina y todos alcanzaron la remisión de la actividad. Tres recayeron y recibieron dos o tres nuevos cursos de la medicación con mejoría sintomática. El rituximab probó ser una droga efectiva para el tratamiento de la conjuntivitis cicatrizal crónica recalcitrante.

Cicatrizing conjunctivitis is the final consequence of several diseases. The most severe among them are cicatricial pemphigoid and chronic Stevens-Johnson syndrome. Systemic immunosuppressive drugs and steroids are usually an effective approach to these diseases. However, a few patients follow a recalcitrant course unremitting to usual therapy. We describe the treatment with rituximab of seven patients with cicatricial pemphigoid and two with chronic Stevens-Johnson syndrome. Eight of them also received gammaglobulin and all achieved clinical remission. Three relapsed and required two or three new courses of rituximab with good control of disease activity. Rituximab proved to be an efficacious drug for chronic recalcitrant cicatrizing conjunctivitis.

Ojos rojos y lesiones cutáneas: síndrome de Sweet histiocitoide / Red eyes and skin lesions: Sweet histiocytoid syndrome

No disponible

Linfoma folicular primario de la conjuntiva simulando conjuntivitis crónica / Primary conjunctival follicular lymphoma mimicking chronic conjunctivitis

CASO CLÍNICO: Paciente varón de 43 años con conjuntivitis folicular crónica resistente a tratamiento local, y serologías para bacterias negativas. Se realizó biopsia incisional que fue compatible con hiperplasia reactiva linfoide. Un año después, una nueva biopsia mostró un linfoma folicular, sin afectación sistémica, que fue tratado con radioterapia local. DISCUSIÓN: Ante una conjuntivitis folicular crónica resistente a tratamiento convencional es esencial realizar una biopsia incisional para el diagnóstico histopatológico, que puede abarcar desde la inflamación crónica y la hiperplasia reactiva linfoide al linfoma. El linfoma folicular es raro entre los linfomas de conjuntiva y la estadificación es indispensable para un correcto abordaje terapéutico

CLINICAL CASE: The case is presented of a 43 year-old male patient with chronic follicular conjunctivitis, negative bacterial serology, and refractory to local treatment. The incisional biopsy performed showed to be consistent with reactive lymphoid hyperplasia. A year later, a new incisional biopsy showed follicular lymphoma, with no systemic involvement, and he was treated with local radiotherapy. DISCUSSION: When a chronic follicular conjunctivitis is refractory to treatment, it is essential to perform an incisional biopsy to establish the histopathological diagnosis that can range from chronic inflammation, reactive lymphoid hyperplasia to lymphoma. Follicular lymphoma is rare among conjunctival lymphomas, and the staging is indispensable for the correct therapeutic approach

Successful Treatment with Chronic Conjunctivitis: Removal of Tarsoconjunctival Crypt

No abstract available.

Metotrexato como tratamiento en el penfigoide ocular cicatricial moderado / Methotrexate as a treatment in ocular cicatricial moderate pemphigoid

CASO CLÍNICO: Una mujer de 73 años se presenta con historia de molestias inespecíficas y fotofobia en ambos ojos (AO) de un año de evolución. A la exploración se observa un simbléfaron bilateral y acortamiento de fondos de saco. El análisis inmunohistoquímico (IHQ) confirma la presencia de un depósito lineal de Ig G, Ig M y C3 a lo largo de la membrana basal conjuntival. Ante el diagnóstico de penfigoide ocular cicatricial (POC) se pauta tratamiento sistémico mediante metotrexato (MTX) subcutáneo. DISCUSIÓN: Consideramos dicho tratamiento una alternativa inmunosupresora inicial muy eficaz en pacientes con inflamación conjuntival moderada y en casos de rápida progresión

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression

Eficacia de la aplicación tópica de 0, 3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas / Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction

Objetivo: Determinar la eficacia de la ciprofloxacina tópica al 0,3% en la reducción de la biota conjuntival en pacientes operados de cataratas. Pacientes y métodos: Estudio experimental, prospectivo, aleatorizado, controlado a simple ciego. Cuarenta y seis ojos de 46 pacientes fueron distribuidos al azar en dos grupos: el grupo de estudio (n = 23) recibió ciprofloxacina al 0,3% un día antes de la cirugía a razón de una gota cada 6 h y, luego, en el día de la cirugía, una gota cada 15 min, empezando una hora antes de la cirugía hasta completar tres dosis; el grupo control (n = 23) no recibió antibiótico; en ambos grupos para el campo quirúrgico se utilizó iodopovidona al 10%. Se tomaron muestras de la conjuntiva en cuatro momentos diferentes, cultivadas en medios sólidos (agar chocolate, agar sangre) y en caldo de enriquecimiento (tioglicolato). Además se obtuvieron muestras de humor acuoso que fueron cultivadas en tioglicolato. La presencia de bacterias fue identificada cuantitativa y cualitativamente y la frecuencia de contaminación fue medida considerando el desarrollo de microorganismos en los medios de cultivo tanto líquido como sólido, y se contabilizaron los números de colonias (UFC) en el sólido. Resultados: Antes de la administración de ciprofloxacina al 0,3% se obtuvieron cultivos positivos en el 82,6 y 78,3% de los pacientes en los grupos de estudio y control, respectivamente. La administración de ciprofloxacina al 0,3% redujo significativamente las UFC en comparación con el grupo control (p < 0,05); inmediatamente después del uso de la iodopovidona el porcentaje de pacientes con cultivo positivo disminuyó a 21,7% en el grupo de estudio y a 8,7% en el grupo control; al final de la cirugía este porcentaje fue de 26 y 30,4%, respectivamente. El germen más frecuente fue el estafilococo coagulasa-negativo (66,7%) (AU)

Conclusión: La administración de ciprofloxacina al 0,3% reduce la carga bacteriana conjuntival en el período preoperatorio, pero no la erradica de forma significativa. La administración de iodopovidona erradica la biota conjuntival en el 50-70% de los pacientes operados de cataratas (AU)

Objective: To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. Patients and methods: Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n = 23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15 minutes starting one hour before surgery until 3 doses were completed. The control group (n = 23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. Results: Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P < 0.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%) (AU)

Conclusion: The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery (AU)

Análisis bacteriológicos en el tratamiento de las conjuntivitis. Comparación de la resistencia a antibióticos entre 1982 y 2008 / Bacteriological analysis in the management of conjunctivitis. Comparison of antibiotic resistance between 1982 and 2008

Objetivo: Mostrar la necesidad de análisis bacteriológicos para un tratamiento racional de las infecciones de la superficie ocular, incluyendo las conjuntivitis. Métodos: Los resultados de 1.970 análisis bacteriológicos consecutivos, obtenidos desde 2001 a 2008, en pacientes con hiperemia conjuntival y secreción fueron contados y comparados con un estudio similar realizado en 1982 en la misma área geográfica. Resultados: Se obtuvo crecimiento bacteriano en 1.044 casos (53%). Las bacterias más frecuentes fueron Staphylococci spp. (56,6%), seguidos de Streptococci spp. (21,4%), Haemophili spp. (12,1%) y otras bacterias gram-negativas (9,9%). Ningún antibiótico fue eficaz frente a todas las bacterias aisladas. La frecuencia de bacterias resistentes a la neomicina, tobramicina, eritromicina y gentamicina estaba significativamente aumentada con respecto al estudio de 1982. Conclusiones: Los análisis bacteriológicos de las muestras obtenidas de la conjuntiva son necesarios para asegurar la elección de un antibiótico efectivo frente a las bacterias de la superficie ocular cuando fracasa el tratamiento inicial(AU)

Objective: To demonstrate the need for bacteriological analysis for the rational treatment of infections of the corneal surface, including conjunctivitis. Methods: The results of 1,970 consecutive bacteriological analysis obtained from 2001 to 2008 in patients with ocular hyperemia and discharge were analysed and compared with a similar study done in 1982 in the same geographical area. Results: Bacterial growth was obtained in 1,044 cases (53%). The most frequent bacteria were Staphylococci spp. (56.6%), followed by Streptococci spp. (21.4%), Haemophili spp. (12.1%), and other gram-negative bacteria (9.9%). No antibiotic was effective against all the bacteria isolated. The frequency of resistant bacteria against neomycin, tobramycin, erythromycin and gentamicin was significantly increased with respect to the study of 1982. Conclusions: Bacteriological analysis of conjunctival specimens are necessary to ensure the choice of an effective antibiotic against bacteria of the ocular surface when the initial treatment fails(AU)