Viral conjunctivitis is one of the most common disorders observed in ophthalmic emergency departments, yet no established treatment exists. Lately, antiviral medications have been introduced into clinical practice; however, a systematic review focusing on their use and effectiveness in the treatment of viral conjunctivitis has not been previously reported. We systemically reviewed the literature to identify studies where antiviral drugs were used to treat viral conjunctivitis. Currently, aciclovir, trifluridine and valaciclovir are commonly used as antiviral agents to treat herpesvirus infections. Cidofovir has been used successfully to treat some cases of adenoviral conjunctivitis, although toxicity has also been reported. The use of other medications, such as idoxuridine, has been minimized in clinical practice due to their high toxicity. Interestingly, most of the antiviral drugs developed are used to treat herpesvirus infections, while less progress has been made in the field of adenoviral infections. For other viral causes of conjunctivitis, no effective remedy is currently available, and treatment focuses on the relief of symptoms. Caution should be exercised when coadministering other pharmacological agents, such as corticosteroids, because of emerging adverse effects.

Bacterial conjunctivitis is common and occurs in patients of all ages. Typical signs are a red eye and purulent drainage that persists throughout the day. Gonococcal and chlamydial conjunctivitis must be treated with systemic antibiotics. Bacterial conjunctivitis due to most other organisms can be treated empirically with topical antibiotics. Red flags suggesting a complicated case requiring referral to an ophthalmologist include reduced vision, severe eye pain, a hazy-appearing cornea, contact lens use, and poor response to empirical treatment.

In 84% of 700 consecutive cases of untreated acute conjunctivitis subjected to conjunctival cultures and scrapings, a presumptive etiologic diagnosis could be made based on standard microbiologic and cytologic criteria. Of these 583 cases, 264 were bacterial, 245 were viral, 51 were allergic, and 17 were chlamydial. In 75% of the cases, clinical impressions were consistent with laboratory findings. On the basis of these results, laboratory workup is recommended in (1) follicular conjunctivitis to differentiate viral from chlamydial processes, (2) purulent conjunctivitis to identify pathogens and decide on appropriate antimicrobial therapy based on sensitivity data, and (3) those cases in which the clinical picture is not sufficiently distinctive to suggest an etiologic diagnosis.

With the emergence of chlamydia as a major cause of neonatal conjunctivitis, silver nitrate is no longer the prophylactic agent of choice in many parts of the world. We studied 450 consecutive newborns in north-eastern Zaire in an effort to determine which of two agents provided the most effective prophylaxis. None of 236 newborns treated at birth with 1% silver nitrate and none of 123 treated with 1% tetracycline was found to develop conjunctivitis. Three of 91 "forgotten" babies developed gonococcal conjunctivitis. Nurses, thinking tetracycline was "messy", tended to "forget" to treat babies for whom tetracycline was prescribed. The use of silver nitrate still provides adequate prophylaxis in Zaire. Potential changes in the prophylactic regimen would need to take the perceptions of health care workers into account.

PURPOSE:

To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis.

DESIGN:

Systematic review and meta-analysis.

PARTICIPANTS:

Seven qualified studies incorporating 306 eyes of 153 patients were analyzed.

METHODS:

Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform.

MAIN OUTCOME MEASURES:

We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effects model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation).

RESULTS:

At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], -1.21; 95% confidence interval [CI], -1.80 to -0.62; I(2) = 71%) and symptoms (SMD, -0.84; 95% CI, -1.51 to -0.16; I(2) = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, -61.16; 95% CI, -101.61 to -20.72; I(2) = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19-35.06; I(2) = 73%) was common in both the cyclosporine and placebo groups.

CONCLUSIONS:

This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.

There has been uncertainty about whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of acute bacterial conjunctivitis. Using standard Cochrane search methods, we identified double-blind randomised controlled trials in which any form of antibiotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extraction and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Six published trials were identified, of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days 2 to 5: relative risk (RR) = 1.31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission, and early and late microbiological remission. Since trials to date have been conducted in selected specialist care patient populations, generalisation of these results to a primary care-based population should be undertaken with a degree of caution.

OBJECTIVE:

This meta-analysis was designed to assess the efficacy, as well as the safety of loteprednol etabonate (LE) ophthalmic suspension compared with placebo and other commonly used eye drops for treatment of allergic conjunctivitis.

METHODS:

Comprehensive searches of randomized controlled trials were carried out in database of Medline, Embase and the Cochrane Library. Eight qualified studies were included. We assessed the reduction from baseline in scores of cardinal signs and symptoms, proportion of patients with improvement of allergic signs and symptoms and incidence of clinically significant intraocular pressure (IOP) elevation (IOP elevation ≥ 10 mmHg).

RESULTS:

The results showed that topical LE was significantly superior to placebo in reduction from baseline in signs scores (standardized mean differ ence [SMD], -0.48; 95% confidence interval [CI], -0.65 to -0.32) and symptoms scores (weighted mean difference (WMD), -0.51; 95% CI, -0.64 to -0.38) of allergic conjunctivitis, and as effective as olopatadine and fluorometholone acetate. Topical LE was associated with higher improvement rate of signs (risk ratio [RR], 1.53; 95% CI, 1.26 to 1.86; I(2) =57%) and symptoms (RR, 1.29; 95% CI, 1.15 to 1.46; I(2) =54%) than placebo and positive control treatment. Clinically significant IOP elevation was more frequent in group of LE than group of control treatment (pooled OR, 3.03; 95% CI, 1.04 to 8.80), which was affected by the response to corticosteroid of the individual patient, the wearing of contact lenses.

CONCLUSIONS:

Topical LE is effective in treating allergic conjunctivitis. However, it should be used with caution due to higher incidence of IOP elevation compared with placebo and olopatadine. A large-scale trial would be required to confirm the effect of different concentrations of LE on IOP.

Se pesquisan los casos con queratoconjuntivitis flictenular en la Asistencia Publica de Santiago durante dos meses, de los cuales se tomaron 60 pacientes y se efectua estudio etiologico con; radiografia de torax, P.P.D., hemograma y VHS, frotis conjuntival, cultivo conjuntivales, busqueda de foco septico oral, baciloscopia.Se los divide al azar en tres grupos y, por metodo doble ciego, se los trata con placebo, gentamicina y colirio gentamicina + dexametasona. La QCF constituye el 3,4% de las consultas y el 15,1% de las conjuntivitis. Mujeres fueron el 8l,1% y el 86.6% de los casos tiene entre 6 y 20 anos. Ningun caso se atribuyo a tuberculosis, solo se encontro PPD positivo en un tercio de los pacientes que creemos se debe a alergia a la vacuna BCG. En el 12% el cultivo encontro algun germen patogeno, el germen mas frecuente fue estafilococo dorado. El 53,3% revelo algo positivo como cultivo, o blefaritis, o acne, o foco septico oral. No hubo sospecha de etiologia viral. La lesion desaparece mas precozmente con gentamicina o colirio mixto de gentamicina con dexametasona que al tratarla con placebo (P= 0,01). Mientras que el paciente no encuentra diferencia en la desaparicion de los sintomas al tratarla con cualquiera de los tres tratamientos (P= 0,05)

OBJECTIVE:

Acute conjunctivitis is an extremely common condition and can be associated with significant morbidity and economic burden. Despite this, considerable controversy exists pertaining to the prevalence, diagnosis, management, and treatment of the condition. A panel of ophthalmology experts was assembled to review and discuss the current evidence based literature as it pertains to each of these persistent controversies.

METHODS AND SCOPE:

An acute conjunctivitis round table symposium was convened at the American Academy of Ophthalmology meeting in Atlanta, November 2008. The expert panelists consisted of four academic ophthalmologists in the field of cornea and external disease, whose discussion was informed by an English language literature survey carried out on the PubMed database for the period of January 1972 to October 2008. A narrative summary was generated from the literature review and direct transcription of this event, from which this Review article was developed.

FINDINGS AND CONCLUSIONS:

Considerable light has been shed on acute microbial conjunctivitis and especially those cases caused by adenovirus. Many of the myths that have perpetuated for years have been debunked by emerging evidence. The advent and the implementation of better diagnostic tools and anti-viral medications will help clinicians to improve their diagnostic accuracy, improve management and treatment decisions, and ultimately benefit patients while saving overall healthcare costs.

The eye has become the target of intense pharmacologic development because it represents one of the most active sites of allergic inflammation, due to it having no mechanical barrier to prevent the impact of allergens such as pollen on its surface. Over the past 20 years, we have witnessed an astonishing growth in therapeutic advances, ranging essentially from derivatives of simple aspirin to various newly developed biological immunomodulatory agents, using implantable drug delivery devices that exceed the safety and efficacy of those available for other organ systems and resorting to advanced surgical techniques for the correction of sight-threatening, disease-related complications. Overall, with the expanding knowledge base, the intricacy of ocular inflammation appears to be becoming ever more manageable and the clinical allergist/immunologist has an increasing role in the treatment outcomes of patients with anterior inflammatory disorders of the ocular surface primarily allergic conjunctivitis but also including dry eye syndromes.