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These cannot be seen with fluorescein dye, and can take several weeks to resolve spontaneously.Bacterial conjunctivitis is usually caused by Streptococcus pneumoniae, Haemophilis influenzae, Staphylococcus aureus or Moraxella catarrhalis. Less commonly, Chlamydia trachomatis or Neisseria gonorrhoeae may be the causative organism. Symptoms are similar to viral conjunctivitis, but discharge is usually mucopurulent and may cause the eyelids to become “glued” together after sleeping.11 Symptoms are usually moreArtificial tears and lubricantsThe discomfort of dry or irritated eyes may be relieved by the use of tear replacement preparations (artificial tears) and ocular lubricants. Lubricants are generally thicker, ointment-based products, which can cause blurred vision, therefore are most appropriate for use overnight. Lubricants generally should not be used while wearing contact lenses.Artificial tear preparations traditionally contain hypromellose, carmellose, carbomers, polyvinyl alcohol, povidone (an antiseptic) or sodium hyaluronate. Sodium chloride solution is often used by people who wear contact lenses, to relieve discomfort. Paraffin is a common ocular lubricant. The range of lubricating eye preparations (with a preservative) that are fully subsidised without restrictions has widened to include thick and thin artificial tear drops, a gel and an eye ointment. Some products are also available for purchase over-the-counter. Check the New Zealand Formulary or Pharmaceutical Schedule for subsidy information before prescribing.Preservative-free eye preparations now subsidisedEye treatments prepared in multi-use bottles or tubes contain a preservative to prevent contamination. This preservative is often mildly toxic to the corneal epithelium, leading to a toxic keratopathy (non-inflammatory disease of the cornea) in patients sensitive to these agents, or those receiving these drops frequently and long-term.subject to Special Authority criteria. The Special Authority requirements are that patients must have a confirmed diagnosis, with slit lamp, of severe secretory dry eye, and either require eye drops more than four times daily on a regular basis or have a confirmed allergic reaction to preservative in eye drops. Therefore preservative-free eye preparations are likely to be initiated by an Ophthalmologist and continued in general practice.The preparations available with Special Authority are:Sodium hyaluronate eye-drops 1 mg/mL ( Hylo-Fresh), a preservative-free thin lubricating eye-drop; available from 1 July, 2013. N.B. In contrast to most eye preparations which have a one month expiry after opening, Hylo-Fresh has a six month expiry after opening. Macrogol 400 0.4% with propylene glycol 0.3% eye drops (Systane Unit Dose), a preservative-free thick lubricating eye-drop; available from 1 August, 2013 Carbomer ophthalmic gel 0.3% (Poly-gel), a preservative-free lubricating gel; available from 1 August, 2013Retinol palmitate 138 micrograms/g ophthalmic ointment (VitA-POS) is available from 1 July, 2013, fully subsidised (without restrictions).
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