INTRODUCTION: Most cases of conjunctivitis in adults are probably due to viral infection, but children are more likely to develop bacterial conjunctivitis than they are viral forms. The main bacterial pathogens are Haemophilus influenzae and Streptococcus pneumoniae in adults and children, and Moraxella catarrhalis in children. Contact lens wearers may be more likely to develop gram-negative infections. Bacterial keratitis occurs in up to 30 per 100,000 contact lens wearers. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical treatment in adults and children with suspected bacterial conjunctivitis? What are the effects of treatment in adults and children with bacteriologically confirmed bacterial conjunctivitis? What are the effects of treatment in adults and children with clinically confirmed gonococcal conjunctivitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 44 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: ocular decongestants, oral antibiotics, parenteral antibiotics, saline, topical antibiotics, and warm compresses.

INTRODUCTION: Most cases of conjunctivitis in adults are probably due to viral infection, but children are more likely to develop bacterial conjunctivitis than they are viral forms. The main bacterial pathogens are Haemophilus influenzae and Streptococcus pneumoniae in adults and children, and Moraxella catarrhalis in children. Contact lens wearers may be more likely to develop gram-negative infections. Bacterial keratitis occurs in up to 30 per 100,000 contact lens wearers. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical treatment in adults and children with suspected bacterial conjunctivitis? What are the effects of treatment in adults and children with bacteriologically confirmed bacterial conjunctivitis? What are the effects of treatment in adults and children with clinically confirmed gonococcal conjunctivitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: ocular decongestants; oral antibiotics; parenteral antibiotics; saline; topical antibiotics; and warm compresses.

Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. It is the most common cause of "red eye". The etiology can usually be determined by a careful history and an ocular examination, but culture is occasionally necessary to establish the diagnosis or to guide therapy. Conjunctivitis is commonly caused by bacteria and viruses. Neisseria infection should be suspected when severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate three to five days postpartum. Conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is usually self-limited. Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis. Treatment requires good eyelid hygiene and the application of topical antibiotics as determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen exposure. This condition is generally treated with topical antihistamines, mast-cell stabilizers or anti-inflammatory agents.

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OBJECTIVE: To evaluate the role of besifloxacin in bacterial conjunctivitis treatment. DATA SOURCES: Searches were made on MEDLINE/PubMed and EMBASE (January 2007 to January 2014) using the terms besifloxacin and Besivance. References from these publications were reviewed for additional resources. Additional information was collected from Bausch & Lomb, the manufacturer of Besivance; www.clinicaltrials.gov; and American Academy of Ophthalmology. STUDY SELECTION AND DATA EXTRACTION: English-language documents were reviewed for pharmacology, pharmacokinetics, efficacy, and safety, with priority on clinical trials. DATA SYNTHESIS: Three large randomized controlled clinical trials established the safety and efficacy of besifloxacin ophthalmic suspension 0.6% compared with placebo or active comparator (moxifloxacin ophthalmic solution 0.5%) given 3 times a day for 5 days for acute bacterial conjunctivitis (BC) treatment. Compared with placebo, besifloxacin had clinically superior bacterial eradication rates and was noninferior to moxifloxacin. Besifloxacin was compared with placebo in 2 randomized, placebo-controlled trials, dosed twice a day for 3 days. Superior efficacy was seen compared with placebo, which supports the shorter dosing schedule. Ophthalmic besifloxacin is well tolerated; the most common adverse effect (conjunctival redness) occurred in 2% of patients. Adverse effects in 1% to 2% of patients included blurred vision, eye pain, eye irritation, eye pruritus, and headache. CONCLUSION: Besifloxacin 0.6% ophthalmic suspension 3 times a day for 5 days is safe and effective for BC. Twice-a-day dosing for 3 days was also effective-a simplified regimen compared with other fluoroquinolones. Disadvantages include price and lack of a generic. Further evaluation is needed to evaluate comparative efficacy among other ocular fluoroquinolones and unlabeled uses.

IMPORTANCE: Conjunctivitis is a common problem. OBJECTIVE: To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis. EVIDENCE REVIEW: A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references. FINDINGS: Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors. CONCLUSIONS AND RELEVANCE: The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.

Acute bacterial conjunctivitis is the eye disease most commonly seen by general practitioners, and is estimated to represent approximately 1% of all consultations in primary care. This article gives a review of the epidemiology, aetiology, clinical picture, complications, differential diagnoses, in vitro examinations and therapy of acute bacterial conjunctivitis. Until now, topical antibacterial therapy has generally been preferred by both physicians and patients because this will usually shorten the course of the disease slightly and allow the early readmittance of children to their kindergarten or school. Recently, several reports from primary care have confirmed the well-known clinical experience that the disorder has an excellent prognosis with a high frequency of spontaneous remission. In accordance, an expectant attitude or delayed prescription policy are now frequently strongly recommended. However, these reports also emphasize the difficulty in making a correct clinical distinction between bacterial and viral conjunctivitis. The effect of a general non-prescription attitude on transmission rates of pathogens also remains to be clarified. This must be born in mind when deciding how these patients should be handled. The socioeconomic and medical pros and cons of different treatment policies are discussed, and a highly personal view on the optimal handling strategy for these patients is also presented.

PURPOSE OF REVIEW: To describe currently available epidemiological data on the prevalence of allergic conjunctivitis. Allergic conjunctivitis is often underdiagnosed and consequently undertreated except when it is severe and the chief complaint of a consultation in a specialty clinic. Use of healthcare resources and reduced quality of life of affected individuals justify studies on the prevalence of allergic conjunctivitis. RECENT FINDINGS: The association of allergic nasal and ocular symptoms (rhinoconjunctivitis) is common. Most children with allergic conjunctivitis have allergic rhinitis. Older population studies estimate a prevalence of 15-20% of allergic conjunctivitis, but more recent studies implicate rates as high as 40%. Ocular symptoms are common and contribute to the burden of allergic rhinitis and lower quality of life. Ocular allergies rank a very close second and at times may overcome the primary complaints of nasal congestion in rhinoconjunctivitis patients. SUMMARY: Little focus has been set on the impact of allergic conjunctivitis as comorbidity to asthma and rhinitis in atopic patients. Conjunctivitis symptoms are at least as severe as rhinitis symptoms in patients with 'hay fever' and some have even generated the term of conjunctivorhinitis stressing the ocular symptoms. Prevalence studies should be specifically addressed to ocular allergy symptoms.

OBJECTIVE: To evaluate the safety and efficacy of alcaftadine for the prevention of itching associated with allergic conjunctivitis. DATA SOURCES: A medical literature search was conducted in MEDLINE/PubMed (2006-February 2012) and EMBASE (2006-February 2012) using the search terms alcaftadine and Lastacaft. References from these publications were reviewed for additional resources. Additional information was collected from Web sites of the US government (http://www.clinicaltrials.gov, http://www.fda.gov) and of Allergan Inc., the manufacturer of Lastacaft (http://www.lastacaft.com). STUDY SELECTION AND DATA EXTRACTION: All identified articles and publications in English were reviewed for pharmacology, pharmacokinetics, efficacy, and safety data. Priority was placed on clinical trials. DATA SYNTHESIS: Two published clinical trials evaluated the efficacy of alcaftadine in the prevention of ocular itching and conjunctival redness associated with allergic conjunctivitis. One trial compared alcaftadine to placebo, and another trial compared alcaftadine to placebo and olopatadine HCl to placebo. Both studies showed superior efficacy, both clinically and statistically, in the prevention of ocular itching associated with allergic conjunctivitis compared to placebo. Although conjunctival redness was evaluated in the 2 trials, neither trial demonstrated both clinical and statistical significance. Both trials demonstrated a rapid onset of action of less than 15 minutes, as well as a duration of action greater than 16 hours, which supports the use of once-daily administration. Overall, alcaftadine was well tolerated, and common adverse effects, reported in less than 4% of patients, included ocular irritation, pruritus, erythema, and stinging or burning upon instillation. Ocular adverse effects were typically mild in severity and self-limiting. CONCLUSIONS: Alcaftadine is a safe and effective option for the prevention of ocular itching associated with allergic conjunctivitis, is dosed once daily, and is competitively priced among prescription medications for allergic conjunctivitis. Additional studies are needed to further evaluate the comparative efficacy among ocular antihistamine/mast cell stabilizing medications.

ANTECEDENTES: Aunque con frecuencia se les da poca importancia, los síntomas oculares alérgicos son frecuentes y representan una comorbilidad importante de la rinitis alérgica. La inmunoterapia sublingual (ITSL) es un tratamiento bien tolerado y eficaz para la rinitis alérgica, pero sus efectos sobre los síntomas de la alergia ocular no han sido bien establecidos. OBJETIVOS: Evaluar la eficacia de la ITSL en comparación con placebo para reducir los síntomas oculares, los requerimientos de medicación ocular tópica y la sensibilidad conjuntival inmediata a los alergenos. ESTRATEGIA DE BÚSQUEDA: Se hicieron búsquedas en CENTRAL (que contiene el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Trastornos de los Ojos y la Visión [Cochrane Eyes and Vision Group]) (Cochrane Library 2011, número 1), MEDLINE (enero 1950 hasta enero 2011), EMBASE (enero 1980 hasta enero 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (enero 1982 hasta enero 2011), Web of Science (enero 1970 hasta enero 2011), Biosis Previews, (enero 1979 hasta enero 2011), el metaRegister of Controlled Trials (mRCT) (www.controlledtrials.com) (enero 2011), ClinicalTrials.gov (www.clinicaltrials.gov) (enero 2011), el Australian New Zealand Clinical Trials Registry (ANZCTR) (www.actr.org.au) (julio 2010), SCOPUS (noviembre 2008) y la UK Clinical Trials Gateway (enero 2010). No hubo restricciones de idioma o de fecha en la búsqueda de ensayos. La última búsqueda en todas las bases de datos electrónicas, excepto SCOPUS, la UK Clinical Trials Gateway y ANZCTR se hizo el 19 de enero 2011. CRITERIOS DE SELECCIÓN: Ensayos controlados con asignación aleatoria (ECAs), doble ciego y controlados con placebo, que evaluaron la eficacia de la ITSL en pacientes con síntomas de rinoconjuntivitis alérgica (RCA) o conjuntivitis alérgica (CA). OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Las puntuaciones totales de los síntomas oculares fueron la medida de resultado primaria. Las medidas de resultado secundarias incluyeron las puntuaciones individuales de los síntomas oculares (como prurito en los ojos, ojos enrojecidos, ojos acuosos, ojos inflamados), las puntuaciones de la medicación ocular (gotas oftálmicas) y la sensibilidad conjuntival inmediata a los alergenos (SCIA). Los datos se analizaron e informaron como diferencias de medias estandarizadas (DME) mediante el programa informático Review Manager. RESULTADOS PRINCIPALES: Cuarenta y dos ensayos (n = 3 958 participantes totales; n = 2 011 ITSL y n = 1947 placebo) tuvieron datos disponibles para evaluar la eficacia de la ITSL en la CA y se incluyeron en los metanálisis. La heterogeneidad entre los estudios (estadística I2) fue alrededor del 50% o menor para todas las variables principales de evaluación. La inmunoterapia sublingual produjo una reducción significativa en las puntuaciones totales de los síntomas oculares (DME −0,41, intervalo de confianza [IC] del 95%; −0,53 a −0,28; P < 0,00001; I2 = 59%) y en las puntuaciones individuales de los síntomas oculares para los ojos enrojecidos (DME −0,33, IC del 95%: −0,45 a −0,22; P < 0,00001; I2 = 27%), el prurito en los ojos (DME −0,31, IC del 95%: −0,42 a −0,20; P < 0,00001; I2 = 46%) y los ojos acuosos (DME −0,23, IC del 95%: −0,34 a −0,11; P < 0,0001; I2= 42%) comparado con el placebo. Los participantes que recibieron tratamiento activo mostraron un aumento en la dosis umbral para la prueba de provocación conjuntival con alergenos (DME 0,35, IC del 95%: 0,00 a 0,69; P < 0,05; I2 = 43%). No se observaron reducciones significativas en el uso de gotas oftálmicas (DME −0,10, IC del 95%: −0,22 a 0,03; P < 0,13; I2 = 34%). CONCLUSIONES DE LOS AUTORES: En general, la ITSL es moderadamente eficaz para reducir las puntuaciones totales e individuales de los síntomas oculares en pacientes con RCA y CA. Sin embargo, hubo algunas inquietudes acerca de la calidad general de la base de pruebas relacionadas con descripciones inadecuadas de la ocultación de la asignación en algunos estudios, heterogeneidad estadística y con la posibilidad de sesgo de publicación. Se necesitan estudios grandes adicionales con un diseño riguroso que estudien la eficacia a largo plazo después de la interrupción del tratamiento y que establezcan la relación costeefectividad de la ITSL.