(Med Let 2004;46:25)

Cause: Viral, esp adenovirus; allergic; bacterial, mostly unencapsulated pneumococcus in colder climates (Dartmouth students—Nejm 2003;348:1079, 1112), anaerobic strep, Haemophilus, chlamydia, Staph. aureus, Moraxella

95% of remainder after FB. Viral type highly contagious

Sx/Si:Feeling of sand in eye, morning secretions; palpebral and bulbar conjunctival injection, PERRLA and normal vision; preauricular lymph node in chlamydial type; itching is predominant sx in allergic type

Infectious types start in 1 eye, spread to the other; viral type is contagious for >10 d

R/o GC infection if hyperacute

Rx:

(Med Let 2004;46:25)

Sulfacetamide 10%, cheap; polymyxin + Tm/S (Polytrim) gtts cidal rather than static and stings less than sulfa, but $13 generic and $33 trade; or neomycin/polymyxin qid; or tobramycin or gentamicin 0.3% gtts qid, $7 generic, $30+ trade; or moxifloxacin (Vigamox) 1/2%, or gatifloxacin (Zymar) 0.3% tid, but both $45. Not chloramphenicol, which can lead to aplastic anemia. Oral tetracycline or macrolide for chlamydial type. Antibiotics do help shorten crs (Brit J Genl Pract 2001;51:473)

For allergic (Med Let 2004;46:35) topical:

• NSAID ketorlac (Acular) 0.5% i gtt qid (Med Let 1993;35:88); $32/wk; or
• H₁ antihistamine levocabastine (Livostin) (Med Let 1994;36:35) 0.05% i gtt qid, costs $22/2 wk, or similar emedastine (Emadine) i gtt qid; or
• Mast cell stabilizers, cromolyn (Crolom) 4% i-ii gtts ou qid, $15/2 wk; or lodoxamine (Alomide) (Med Let 1994;36:26) 0.1% i-ii gtts qid, costs $14/2 wk; or nedocromil (Alocril); or pemirolast (Alamast)
• Mast cell stabilizer/H₁ antihistamine combos: olopatadine (Patanol) 0.1% i-ii gtts ou bid, $17/wk; or ketotifen (Zaditor) bid, $14/wk; epinastine (Elestat) i gtt bid, $14/wk