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This is a preservative-free lubricating eye ointment for dry eyes. For full details visit: www.pharmac.health.nz orwww.nzf.org.nz16 BPJ Issue 54severe and persistent in patients with conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae (termed hyperacute conjunctivitis).Bacterial conjunctivitis is self-limiting in most people and symptoms resolve without treatment within one to two weeks (although resolution may be more rapid in some people).11, 13 Advise supportive treatment (as for viral conjunctivitis). Avoid the use of cosmetics applied to the eye area as these may be contaminated.There has been much debate as to whether the use of topical antibiotics improves recovery time in people with bacterial conjunctivitis. A 2012 Cochrane review of 11 randomised controlled trials concluded that the use of antibiotic eye drops for bacterial conjunctivitis modestly improved the rate of “clinical and microbiological remission” and was associated with a low risk of serious adverse effects.13 The meta-analysis found that after five days, symptoms had resolved in 30% of patients receiving placebo and in 40% of those receiving a topical broad-spectrum antibiotic. By day ten there was 41% remission in the placebo group and 50% remission in the antibiotic group.13Most patients (or parents of young patients) who present to general practice with bacterial conjunctivitis will expect to receive topical antibiotic treatment. The limitations of treatment should be explained and, if appropriate, offer a “back pocket prescription” and instruct the patient (or parent) to delay starting treatment for a few days to see if the symptoms resolve.11 Antibiotics may be started immediately if symptoms are severe or distressing. The recommended treatment for adults and children aged over two years is chloramphenicol 0.5% eye drops, one to two drops, every two hours for the first 24 hours, then every four hours, until 48 hours after symptoms have resolved. Chloramphenicol 1% eye ointment can also be used at night in patients with severe infections or as an alternative to eye drops for those who prefer this formulation. Fusidic acid 1% eye gel is an alternative to chloramphenicol, and is preferred in women who are pregnant; one drop, twice daily, until 48 hours after symptoms have resolved. Pharmacists who have trained in the diagnosis and management of conjunctivitis may sell chloramphenicol eye preparations, subject to conditions; appropriate verbal and written information on the self-management of eye conditions must be given to all people purchasing these medicines.Laboratory investigations (i.e. a swab) to identify bacteria and sensitivity to antibiotics are not usually required, but may be considered in immunocompromised patients or if symptomsHerpes zoster ophthalmicus (Shingles)Herpes zoster ophthalmicus is essentially shingles (reactivation of the varicella-zoster virus) in the ophthalmic branch of the trigeminal nerve (V).7 All parts of the eye innervated by this nerve can be affected, causing conjunctivitis, keratitis and/or iritis, along with a periorbital vesicular rash, identical to a shingles rash seen elsewhere on the body.
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