Page 40 - NAME OF CONDITION: REFRACTIVE ERRORS

b. Out Patient: All cases of simple conjunctivitis are almost exclusively treated on out
patient basis.
c. Day Care: Not applicable.

d) Referral criteria:

 Infants diagnosed to have ophthalmia neonatorum due to gonococci, chlamydia and
HSV are referred as they need systemic evaluation and appropriate systemic
treatment and more importantly need for counseling the parents.
 Severe conjunctivitis, not responding to treatment to be referred for further
laboratory evaluation in tertiary centre.
 When conjunctivitis appears to be a manifestation of auto immune systemic disease
like Reiters ulcerative colitis etc., then patients should be referred for evaluation by
an appropriate medical specialist.

 Prolonged persistent conjunctivitis with development of complication like
cicatrization, lid abnormalities, and dry eye, symblepharon and punctal anomalies.
 Severe chemical conjunctivitis with limbal ischaemia and suspected intra ocular
penetration of toxic substances to be referred for further management in higher
centre.

*Situation 2: At Super Specialty Facility in Metro location where
higher-end technology is available

a) Clinical Diagnosis:

Apart from the regular history taking, care should be exercised to fully understand
the treatment history of the patient, including all the medications along with the
dosage schedules which were prescribed at the secondary centre. In fact, withdrawal
of strong topical antibiotics may be warranted. A fresh comprehensive clinical

examination, as detailed in the previous section should be performed without being
biased by the referral report.
b) Investigation

As the patients are referred from a secondary centre for a non responsiveness to
treatment or when diagnosis is uncertain or especially in neonatal conjunctivitis
which needs exact etiological diagnosis for initiation of treatment , additional micro
biological and immunological diagnostic tests may be required.

 Culture: Culture and sensitivity of conjunctival scrapings are indicated in all cases of
suspected neonatal conjunctivitis, persons who are immunosuppressed, when N
gonorrhoeae is under consideration as the etiology, recurrent or severe purulent
conjunctivitis and in cases where the conjunctivitis has not responded to medication.
When performed, collect

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