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Refer the infant urgently to a Paediatrician; do not apply topical treatment. If the diagnosis is confirmed, parents will also require testing and possible treatment. Gonorrhoea can result in a sight-threatening eye infection and chlamydia can be associated with the development of pneumonia in young infants.11 N.B. Infants who present with a “sticky eye”, without conjunctival inflammation, are most likely to have poor drainage of the lacrimal duct rather than conjunctivitis, and this does not require urgent assessment.11Allergic conjunctivitis is caused by a local response to an allergen, e.g. pollen, preservatives in eye drops or contact lens solution. Patients typically present with swollen, itching eye(s), irritation, mild photophobia and watery or serous discharge.1 Symptoms are episodic in the case of seasonal allergies. Eversion of the lids often reveals a “cobble-stone” appearance of the tarsal (eyelid) conjunctiva because of the development of large papillae or swellings of the subepithelial stroma (connective tissue).atment is supportive; avoid the allergen where possible, avoid rubbing the eyes, apply a cool or warm compress to relieve symptoms, use artificial tear eye drops if required. If symptoms are severe or other treatments are ineffective, prescribe antihistamine eye drops, e.g. levocabastine, or a mast cell stabiliser (takes several weeks for full effect), e.g. lodoxamide or cromoglicate sodium. Olopatadine eye drops combine antihistamine and mast cell stabilisation activity and are often effective. An oral antihistamine may also be prescribed, depending on patient preference and previous response to treatment.1Patients with severe allergic conjunctivitis should have their visual acuity checked and a fluorescein examination, and then be referred to an Ophthalmologist for further assessment and possible initiation of topical corticosteroids. Vernal and atopic keratoconjunctivitis are two severe forms of allergic eye disease affecting children and young adults respectively, and can be associated with large epithelial defects on the cornea* This is normally the same type of swab as used for genital testing for chlamydia and gonorrhoea – check with your local laboratory (shield ulcers) that can lead to scarring, and also microbial keratitis – especially if topical immunosuppressants are being used.Foreign bodies and corneal abrasionsPatients with a foreign body in their eye or a corneal abrasion typically present with discomfort, watery discharge, pain associated with movement of the eye, blurring of vision and photophobia.5The patient may be aware of the foreign body which has entered the eye or it may have occurred unnoticed during an activity such as chiselling, hammering, grinding metal or mowing the lawn.
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