1. 結膜炎
Conjunctivitis
JAMA. 2013;310(16):1721-1729.
13年10月24日木曜日

2. 結膜
•
結膜は強膜と眼瞼部分を覆う薄い膜.
Review of Conjunctivitis Diagnosis and Treatment
強膜部位をBulbar conjunctiva, 眼瞼部位をPalpebral conjunctivaと呼ぶ
Clinical Review & Education Review
•
Figure 1. Normal Conjunctival Anatomy
Eyelid
Limbus
Bulbar
conjunctiva
Sclera
Bulbar
conjunctiva
Cornea
Iris
Palpebral
conjunctiva
Palpebral
conjunctiva
S AG I T TA L C R O SS S EC T I O N
13年10月24日木曜日
The conjunctiva is a thin membrane
covering the sclera (bulbar
conjunctiva, labeled with purple) and
the inside of the eyelids (palpebral
conjunctiva, labeled with blue).

3. 結膜炎
•
名前の通り結膜の炎症. Conjunctivitisと呼び,
結膜の血管拡張を認め, 浮腫や浸出液を認める.
•
一般的な感染症であり, 眼科よりは一般外来で対応することが多い.
•
感染性ウイルス性が最も多く, 夏場で多い.
細菌性は2番目. 小児例が50-75%を占め, 12月~4月に多い.
アレルギー性は全体で15-40%を占める最多の原因. 春~夏に多い.
•
非感染性ではアレルギー性以外に,
毒素性, 瘢痕性, 自己免疫性, 腫瘍性が挙げられる.
•
全身性疾患に付随するものとして, 淋菌, クラミジア, GVHD, Reiter症候群等.
13年10月24日木曜日

4. Figure 2. Suggested Algorithm for Clinical Approach to Suspected Acute
Conjunctivitis
Suspected acute conjunctivitis
(≤ 4 wk duration)
アプローチ.
•
No
No
Blurred vision?
Yes
Constant
blurred vision?
Yes
No
No
Hyperpurulent
Yes
Gonococcal conjunctivitis
Mucopurulent
Bacterial conjunctivitis
(nongonococcal)
Serous
No
Yes
眼痛や羞明, 複視があれば
Methods
眼科診察が必要.
Yes
Photophobia?
Itching?
プライマリケアでの
Yes
Pain?
Discharge?
•
referral. An algorithmic approach (Figure 2) using a focused
history along with a penlight eye examination may be helpf
agnosis and treatment. Because conjunctivitis and many oth
lar diseases can present as “red eye,” the differential diagnos
eye and knowledge about the typical features of each diseas
category are important (Table 1).
Allergic conjunctivitis
Dry eye disease
No
Ophthalmology referral
Conjunctivitis can be divided into infectious and noninfectious
causes. Viruses and bacteria are the most common infectious causes.
Noninfectious conjunctivitis includes allergic, toxic, and cicatricial
13年10月24日木曜日
TheliteraturepublishedthroughMarch2013wasreviewedby
ing PubMed, the ISI Web of Knowledge database, and the Co
Library. The following keywords were used: bacterial conjun
• 膿性分泌物の場合は
viral conjunctivitis, allergic conjunctivitis, treatment of bacte
junctivitis, and treatment of viral conjunctivitis. No language
淋菌や細菌性を考慮.
tion was applied. Articles published between March 2003 an
2013 were initially screened. After review of titles, abstrac
and 掻痒感が強ければ were identified and sc
• references for the articles, more
Articles and meta-analyses that provided evidence-based in
tionアレルギー性を考慮. treatment of variou
about the cause, management, and
of conjunctivitis were selected. A total of 86 articles were in
in this review. The first study8 was published in 1982 and th
in 2012. A level of evidence was assigned to the recommen
• ただし, 細菌性結膜炎の
presented in Table 2 and Table 3 with the American Heart A
tion58%は掻痒感(+),
grading system: “The strongest weight65%,
熱感 of evidence (A
signed if there are multiple randomized trials with large num
patients. An intermediate weight (B) is assigned if there ar
漿液性浸出液 or 無し が35%
ited number of randomized trials with small numbers of p
careful analyses of non-randomized studies, or observatio

5. •
結膜炎意外のRed eyeを来す疾患群
Review Clinical Review & Education
Review of Conjunctivitis Diagnosis and Treatment
Table 1. Selected Nonconjunctivitis Causes of Red Eyea
Differential Diagnosis
Symptoms
Penlight Examination Findings
Dry eye disease
Burning and foreign-body sensation. Symptoms are usually transient, worse with prolonged reading or watching
television because of decreased blinking. Symptoms are
worse in dry, cold, and windy environments because of
increased evaporation.
Bilateral redness
Blepharitis
Similar to dry eyes
Redness greater at the margins of eyelids
Uveitis
Photophobia, pain, blurred vision. Symptoms are usually
bilateral.
Decreased vision, poorly reacting pupils, constant eye
pain radiating to temple and brow. Redness,
severe photophobia, presence of inflammatory cells in
the anterior chamber.
Angle closure glaucoma
Headaches, nausea, vomiting, ocular pain, decreased
vision, light sensitivity, and seeing haloes around lights.
Symptoms are usually unilateral.
Firm eye on palpation, ocular redness with limbal injection. Appearance of a hazy/steamy cornea, moderately
dilated pupils that are unreactive to light.
Carotid cavernous fistula
Chronic red eye; may have a history of head trauma
Dilated tortuous vessels (corkscrew vessels), bruits on
auscultation with a stethoscope
Endophthalmitis
Severe pain, photophobia, may have a history of eye surgery or ocular trauma
Redness, pus in the anterior chamber, and
photophobia
Cellulitis
Pain, double vision, and fullness
Redness and swelling of lids, may have restriction of the
eye movements, may have a history of preceding sinusitis (usually ethmoiditis)
Anterior segment tumors
Variable
Abnormal growth inside or on the surface of the eye
Scleritis
Decreased vision, moderate to severe pain
Redness, bluish sclera hue
Subconjunctival hemorrhage
May have foreign-body sensation and tearing or be
asymptomatic
Blood under the conjunctival membrane
a
Data are from Cronau et al18 and Leibowitz.1 The examination can be done by shining a penlight in the patient’s affected eye(s).
13年10月24日木曜日

6. 感染性結膜炎
•
Viral conjunctivitis;
•
急性結膜炎の80%はウイルス性.
65-90%はAdenovirusによるものであり, 2つの臨床型がある.
> Pharyngoconjunctival FeverとEpidemic keratoconjunctivitis.
•
Pharyngoconjucnctival Feverとは, 急性の発熱, 咽頭痛, 両側性の結膜炎,
耳介周囲リンパ節腫大を呈する病態
•
Epidemic keratoconjunctivitisはもっと高度な結膜炎を呈し,
多量の水様の浸出液, 浮腫, 充血, 同側のリンパ節腫大を呈する.
•
リンパ節腫大は50%で認められ, 細菌性よりも頻度は高い.
13年10月24日木曜日

7. Table 2. Ophthalmic Therapies for Conjunctivitis
Category
Epidemiology
Acute bacterial
conjunctivitis
135 case per 10 000
population in US3
18.3%-57% of all acute
conjunctivitis7-9,12,13
Type of
Discharge
Mucopurulent
Cause
Treatment
S aureus,
S epidermidis, H influenzae,
S pneumoniae,
S viridans, Moraxella spp
Level of Evidence
for Treatment
Aminoglycosides
B20-22
Tobramycin ointment: 3 ×/d for 1 wk
A23-30
Besifloxacin: 1 drop 3 ×/d for 1 wk
•
Gentamicin
Ointment: 4 ×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
A31-34
Ciprofloxacin ointment: 3 ×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
A24,28,29
Adenovirusによる結膜炎は10-50%で感染播種する.
Fluoroquinolones
•
感染経路は浸出液が付いた手, 物, 医療機器, プール等.
Gatifloxacin: 3 ×/d for 1 week
Levofloxacin: 1-2 drops 4 ×/d for 1 wk
潜伏期間は5-12日間で, 排菌期間は10-14日間. 3 ×/d for 1 wk
Moxifloxacin:
Ofloxacin: 1-2 drops 4 ×/d for 1 wk
B35
B36-38
A34,39,40
A37,38,41,42
Macrolides
特異的な治療は無く, 冷やしたり, 人工涙を使用したり, 1 drop
Azithromycin: 2 ×/d for 2 d; then
A27,30,43,44
Erythromycin:
抗ヒスタミンを使用する等対症療法を行う. 4 ×/d for 1 wk
•
B45
daily for 5 d
Sulfonamides
•
7-10日で改善しない場合や,
Clinical Review & Education Review
B22
Sulfacetamide ointment: 4 ×/d and at
bedtime for 1 wk
Solution: 1-2 drops every 2-3 h for 1 wk
Review of Conjunctivitis Diagnosis and Treatment
Combination drops
合併症を生じた場合は眼科コンサルトの必要がある.
Trimethoprim/polymyxin B: 1 or 2 drops
4 ×/d for 1 wk
NA
Purulent
Hyperacute
Table 2. Ophthalmic Therapies for Conjunctivitis
bacterial
conjunctivitis
in adults
Category
Acute
Viral bacterial
conjunctivitis
conjunctivitis
Herpes zoster
virus
13年10月24日木曜日
Epidemiology
135 case per all 000
9%-80.3% of 10 acute
population in US3
conjunctivitis8-13
18.3%-57% of all acute
conjunctivitis7-9,12,13
NA
Type of
Discharge
Mucopurulent
Serous
Variable
Cause
S aureus, are due to
Up to 65%
S epidermidis, H influenzae,
adenovirus strains49
S pneumoniae,
S viridans, Moraxella spp
Herpes zoster virus
Ceftriaxone: 1 g IM once
C16,47
Lavage of the infected eye
Neisseria gonorrhoeae
A22,40,46
C16
Level of Evidence
for Treatment
C48
Treatment to cover chlamydia is indicated
Dual therapy
Aminoglycosides
Cold compress
Artificial tears
Gentamicin
Antihistamines
Ointment: 4 ×/d for 1 wk
Solution: 1-2 dropsmg: 5 ×/d 1 wk
Oral acyclovir 800 4 ×/d for for 7-10 d
Tobramycin ointment: 3 ×/d for 1 wk
C16,50
B20-22
C16
16
A23-30

8. Tobramycin ointment: 3 ×/d for 1 wk
•
A23-30
Fluoroquinolones
Herpes Conjunctivitis; ヘルペス結膜炎 Besifloxacin: 1 drop 3 ×/d for 1 wk
A31-34
Ciprofloxacin ointment: 3 ×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
•
A24,28,29
Gatifloxacin: 3 ×/d for 1 week
B35
HSVは急性結膜炎の1.3-4.8%を占める原因.
Levofloxacin: 1-2 drops 4 ×/d for 1 wk
Moxifloxacin: 3 ×/d for 1 wk
B36-38
A34,39,40
通常片側で浸出液は水様で, 眼瞼結膜に小水疱性眼瞼炎を生じる.
Ofloxacin: 1-2 drops 4 ×/d for 1 wk
A
37,38,41,42
Macrolides
局所, 経口の抗ウイルス薬は病期を短縮し得る. for 2 d; then 1 drop
Azithromycin: 2 ×/d
daily for 5 d
Erythromycin: 4 ×/d for 1 wk
•
Sulfonamides
VZVも原因となる. V1,2を含む帯状疱疹の場合に生じ,
Sulfacetamide ointment: 4 ×/d and at
bedtime for 1 wk
Solution: 1-2 drops every 2-3 h for 1 wk
A27,30,43,44
B45
B22
眼瞼に生じることが多い(45.8%). 次いで結膜に生じる(41.1%)
Combination drops
角膜の障害を38.2%, ぶどう膜炎を19.1%で生じる. B: 1 or 2 drops
Trimethoprim/polymyxin
Clinical Review & Education Review
NA
Hyperacute
bacterial
conjunctivitis
in adults
Purulent
Neisseria gonorrhoeae
Lavage of the infected eye
Table 2. Ophthalmic Therapies for Conjunctivitis
9%-80.3% of all acute
conjunctivitis8-13
Epidemiology
Serous
Type of
Discharge
Up to 65% are due to
adenovirus strains49
Cause
Acute zoster
Herpes bacterial
conjunctivitis
virus
135
NA case per 10 000
population in US3
18.3%-57% of all acute
conjunctivitis7-9,12,13
Mucopurulent
Variable
S aureus,
Herpes zoster virus
S epidermidis, H influenzae,
S pneumoniae,
S viridans, Moraxella spp
1.3-4.8 of all acute
conjunctivitis9-12
Variable
Herpes simplex virus
C16
Dual therapy to cover chlamydia is indicated
Viral
conjunctivitis
Category
Herpes simplex
virus
A22,40,46
4 ×/d for 1 wk Review of Conjunctivitis Diagnosis and Treatment
Ceftriaxone: 1 g IM once
C16,47
C48
Cold compress
Artificial tears
Treatment
Antihistamines
Aminoglycosides mg: 5 ×/d for 7-10 d
Oral acyclovir 800
Level of Evidence
C16,50
for Treatment
C16
Gentamicin
Oral famciclovir 500 mg: 3 ×/d for 7-10 d
Ointment: 4 ×/d for 1 wk
Oral valacyclovir 1000 mg: 3 wk
Solution: 1-2 drops 4 ×/d for 1×/d for 7-10 d
20-22
BC16
Topical acyclovir: 1 drop 9 for
Tobramycin ointment: 3 ×/d×/d 1 wk
23-30
AC16
Fluoroquinolones mg: 7-10 d
Oral acyclovir 400
C16
C16
Besifloxacin: 1 drop 3 ×/d for×/d for 7-10 d
Oral valacyclovir 500 mg: 3 1 wk
13年10月24日木曜日1.8%-5.6% of all acute
Adult inclusion
Variable
Chlamydia trachomatis
31-34
AC16
Ciprofloxacin ointment: 3once for 1 wk
Azithromycin 1 g: orally ×/d
24,28,29
AB16,51

9. •
Bacterial Conjunctivitis; 細菌性結膜炎
•
細菌性結膜炎の頻度は135/10000.
感染経路は直接感染, 手指を介した感染, 汚染された媒介物より.
また, 外傷や眼球の傷, 免疫抑制状態といった患者側の要素も重要.
•
原因菌としては, Staphylococcal spp > S pneumoniae > H influenzae.
小児ではH influenzae > S pneumoniae > Moraxella catarrhalis.
•
潜伏期間は1-7日, 排菌期間は2-7日程度.
結膜炎は通常7-10日持続する.
•
眼瞼に膿性物質があること, 眼瞼の癒着, 掻痒感(-),
結膜炎の病歴が無い点は細菌性結膜炎を示唆する情報となる.
コンタクトレンズもHigh-riskとなり, Abx点眼を考慮する.
13年10月24日木曜日

10. •
Hyperacute bacterial conjunctivitis;
•
重度の膿性浸出液と視力の低下を伴う結膜炎.
眼瞼の腫脹, 眼圧痛, 耳介周囲リンパ節腫大を伴い,
淋菌が原因となることが多い.
角膜損傷や
•
孔を伴うこともある.
治療はCTRXの筋注.
重度の膿性浸出液がある場合は必ず淋菌をチェックすること.
また, 抗生剤に反応しない例はクラミジアをチェック.
•
Chronic bacterial conjunctivitis;
•
4wk以上持続する結膜炎で, Staphylococcus aureus, Moraxella lacunata,
腸管内細菌が原因として多い.
13年10月24日木曜日

11. rus and may cause harm.16,71
Herpes zoster virus, responsible for shingles, can involve ocular tissue, especially if the first and second branches of the trigeminal nerve are involved. Eyelids (45.8%) are the most common site
of ocular involvement, followed by the conjunctiva (41.1%).72 Corneal complication and uveitis may be present in 38.2% and 19.1%
Good hand hygiene can be used to decrease the spread of acute
viral conjunctivitis.
C16
Bacterial cultures can be useful in cases of severely purulent
conjunctivitis or cases that are recalcitrant to therapy.
C16
It may be helpful to treat viral conjunctivitis with artificial tears,
topical antihistamines, or cold compresses.
C16
Topical steroids are not recommended for bacterial conjunctivitis.
C65
Figure 3. Characteristic Appearance of Bacterial and Viral Conjunctivitis
A Bacterial conjunctivitis
B
Hyperacute bacterial conjunctivitis
A, Bacterial conjunctivitis characterized by mucopurulent discharge and
conjunctival hyperemia. B, Severe purulent discharge seen in hyperacute
bacterial conjunctivitis secondary to gonorrhea. C, Intensely hyperemic
jama.com
m: http://jama.jamanetwork.com/ by JUNKO NAGASUE on 10/22/2013
13年10月24日木曜日
C
Viral conjunctivitis
response with thin, watery discharge characteristic of viral conjunctivitis.
Images reproduced with permission: © 2013 American Academy of
Ophthalmology.
JAMA October 23/30, 2013 Volume 310, Number 16

12. •
細菌性結膜炎の治療
•
60%は1-2wkで自然に治癒する経過となる.
•
抗生剤の点眼は病期を短縮し得るが,
臨床的アウトカムには影響しない.
一部では10%程度の予後改善効果があるとのことで,
通常使用される.
•
S pneumoniae, N gonorrhoeae, H influenzaeは毒性も強く,
組織への侵襲も強い為, 重症化し易い傾向がある.
13年10月24日木曜日

13. Fluoroquinolones
Table 2. Ophthalmic Therapies for Conjunctivitis
Category
Acute bacterial
conjunctivitis
Epidemiology
135 case per 10 000
population in US3
18.3%-57% of all acute
conjunctivitis7-9,12,13
Type of
Discharge
Mucopurulent
Cause
S aureus,
S epidermidis, H influenzae,
S pneumoniae,
S viridans, Moraxella spp
Hyperacute
bacterial
conjunctivitis
in adults
NA
Viral
conjunctivitis
9%-80.3% of all acute
conjunctivitis8-13
Serous
Up to 65% are due to
adenovirus strains49
Herpes zoster
virus
NA
Variable
Herpes zoster virus
Hyperacute
Herpes simplex
bacterial
virus
conjunctivitis
in adults
NA
1.3-4.8 of all acute
conjunctivitis9-12
Viral
Adult inclusion
conjunctivitis
9%-80.3% of all acute
1.8%-5.6%of all acute
8-13
conjunctivitis5,8-11
Serous
Variable
Up to 65% are due to
Chlamydia trachomatis
adenovirus strains49
Allergic
90% of all allergic
NA
15
Serous or
Variable
Pollens zoster virus
Herpes
Herpes zoster
13年10月24日木曜日
Purulent
Besifloxacin: 1 drop 3 ×/d for 1 wk
Neisseria gonorrhoeae
A31-34
Ciprofloxacin ointment: 3 ×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
Treatment
Gatifloxacin: 3 ×/d for 1 week
Aminoglycosides
A24,28,29Evidence
Level of
for Treatment
B35
Levofloxacin: 1-2 drops 4 ×/d for 1 wk
Gentamicin
Ointment: 4 3 for 1 wk
Moxifloxacin:×/d×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
Ofloxacin: 1-2 drops 4 ×/d for 1 wk
Tobramycin ointment: 3 ×/d for 1 wk
Macrolides
Fluoroquinolones
Azithromycin: 2 ×/d for 2 d; then 1 drop
Besifloxacin:
daily for 5 d 1 drop 3 ×/d for 1 wk
Ciprofloxacin 4 ×/d for 3 ×/d
Erythromycin:ointment: 1 wk for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
Sulfonamides
Gatifloxacin: 3 ×/d for 1 week
Sulfacetamide ointment: 4 ×/d and at
Levofloxacin: 1-2
bedtime for 1 wk drops 4 ×/d for 1 wk
Solution: 1-2 drops every wk h for 1 wk
Moxifloxacin: 3 ×/d for 1 2-3
Combination drops
Ofloxacin: 1-2 drops 4 ×/d for 1 wk
Trimethoprim/polymyxin B: 1 or 2 drops
Macrolides
4 ×/d for 1 wk
Azithromycin: 2 ×/d for
Ceftriaxone: 1 g IM once2 d; then 1 drop
daily for 5 d
Lavage of the infected eye
Erythromycin: 4 ×/d for 1 wk
Dual therapy to cover chlamydia is indicated
Sulfonamides
Cold compress
Sulfacetamide
Artificial tears ointment: 4 ×/d and at
bedtime for 1 wk
Antihistamines
Solution: 1-2 drops every 2-3 h for 1 wk
Oral acyclovir 800 mg: 5 ×/d for 7-10 d
Combination drops
Oral famciclovir 500 mg: 3 ×/d for 7-10 d
Trimethoprim/polymyxin B: 1 or 2 drops
Oral valacyclovir 1000 mg: 3 ×/d for 7-10 d
4 ×/d for 1 wk
B36-38
B20-22
A34,39,40
A37,38,41,42
A23-30
A27,30,43,44
A31-34
A24,28,29
B45
B35
B22
B36-38
A34,39,40
A37,38,41,42
A22,40,46
A27,30,43,44
C16,47
C16
B45
C48
B22
C16,50
C16
C16
A22,40,46
C16
C16,47
C16
C16
C16
Dual therapy to cover chlamydia is 7-10 d
Oral valacyclovir 500 mg: 3 ×/d forindicated
Neisseria gonorrhoeae
Herpes simplex virus
Ceftriaxone: 1 g IM once
Topical acyclovir: 1 drop 9 ×/d
Lavage of the 400 mg: 7-10
Oral acyclovir infected eye d
Purulent
Variable
C48
C16
Cold compress
Azithromycin 1 g: orally once
Artificial tears
Doxycycline 100 mg: orally 2 ×/d for 7 d
Antihistamines
Topical antihistamines 5 ×/d for 7-10 d
Oral acyclovir 800 mg:
B16,51
16,50
C16,51
B
C16

14. •
特殊な細菌性結膜炎;
•
MRSA結膜炎; 特殊な例であり, 眼科診察が必要.
VCMによる治療が必要となる.
•
クラミジア結膜炎; 1.8-5.6%を占める.
片側性であり, 陰部感染症も併発(男性54% 女性74%).
結膜充血, 粘性膿性分泌物, Lymphoid follicle formationが
特徴的な所見.
•
淋菌性結膜炎; Hyperacute conjunctivitisの主な原因.
13年10月24日木曜日

15. •
Trachomaによる結膜炎;
TrachomaはChlamydia trachomatis subtypes A~Cによる感染症で
失明の原因となる病態.
粘性膿性分泌物と眼球の異常が主な症状, 所見となる.
晩期の眼球損傷, 結膜炎, 角膜障害が失明の主な原因.
Azithromycin 20mg/kgの単回投与が効果的. Abx点眼は6wk程度使用
TC, EMを3wk使用すること選択肢.
13年10月24日木曜日

16. •
Allergic Conjunctivitis; アレルギー性結膜炎
•
花粉や動物由来抗原等に反応し生じる炎症.
結膜炎の40%を占めるが, 未受診の患者も多い.
•
結膜充血と掻痒感が強いのが特徴.
•
治療は抗原暴露の回避と生理食塩水や人工涙で抗原を薄める.
薬剤では点眼のDecongestant, 抗ヒスタミン, Mast cell stabilizer, NSAID,
ステロイド薬の使用.
•
抗ヒスタミンやDecongestantの長期使用は
反動性血管充血を来す為に注意が必要.
•
ステロイド点眼は白内障や緑内障のリスクを上げる.
13年10月24日木曜日

17. Herpes zoster
virus
NA
Variable
Herpes zoster virus
1.3-4.8 of all acute
conjunctivitis9-12
C16
Oral famciclovir 500 mg: 3 ×/d for 7-10 d
C16
Review of ×/d for 7-10 Diagnosis and Treatment
Oral valacyclovir 1000 mg: 3Conjunctivitis d
C16
Clinical Review & Education Review
Herpes simplex
virus
Oral acyclovir 800 mg: 5 ×/d for 7-10 d
Table 2. Ophthalmic Therapies for Conjunctivitis
Adult inclusion
conjunctivitis
Category
1.8%-5.6% of all acute
conjunctivitis5,8-11
Epidemiology
Variable
Type of
Discharge
Chlamydia trachomatis
Cause
Acute bacterial
Allergic
conjunctivitis
conjunctivitis
135 case per 10 000
90% of all allergic
population in 15 3
US
conjunctivitis ;
18.3%-57% of all acute
up to 40% of 7-9,12,13
conjunctivitis
population may be
affected15
Mucopurulent
Serous or
mucoid
S aureus,
Pollens
S epidermidis, H influenzae,
S pneumoniae,
S viridans, Moraxella spp
C16
C16
Oral valacyclovir 500 mg: 3 ×/d for 7-10 d
Herpes simplex virus
Topical acyclovir: 1 drop 9 ×/d
Oral acyclovir 400 mg: 7-10 d
Variable
C16
Azithromycin 1 g: orally once
Treatment
Doxycycline 100 mg: orally 2 ×/d for 7 d
B16,51of Evidence
Level
for Treatment
B16,51
Aminoglycosides
Topical antihistamines
Gentamicin
Azelastine 0.05%: 1 drop 2 ×/d
Ointment: 4 ×/d for 1 wk
Solution: 1-2 drops 4 ×/d 4 1 wk
Emedastine 0.05%: 1 dropfor×/d
Tobramycin cell inhibitors
Topical mastointment: 3 ×/d for 1 wk
20-22
B52
A
A52
A23-30
Fluoroquinolones
Cromolyn sodium 4%: 1-2 drops every 4-6 h
Besifloxacin: 1 drop 3 drops 1 wk
Lodoxamide 0.1%: 1-2×/d for4 ×/d
A52
A31-34
A52
Ciprofloxacin ointment: 3 2 ×/d
Nedocromil 2%: 1-2 drops ×/d for 1 wk
Solution: 1-2 drops 4 ×/d for 1 wk
NSAIDs
Gatifloxacin: 3 ×/d for 1 week
Ketorolac: 1 drop 4 ×/d
Levofloxacin: 1-2 drops 4 ×/d for 1 wk
Vasoconstrictor/antihistamine
Moxifloxacin: 3 ×/d for 1 wk
Naphazoline/pheniramine: 1-2 drops up to
Ofloxacin: 1-2 drops 4 ×/d for 1 wk
4 ×/d
Macrolides
Combination drops
A24,28,29
A52
Azithromycin: 2 ×/d drop d; then
Ketotifen 0.025%: 1 for 2 2-3 ×/d1 drop
daily for 5 d
Olopatadine 0.1%: 1 drop 2 ×/d
Erythromycin: 4 ×/d for 1 wk
Abbreviations: IM, intramuscularly; NA, not available; NSAIDs, nonsteroidal anti-inflammatory drugs.
Sulfonamides
Sulfacetamide ointment: 4 ×/d and at
bedtime for 1 wk
Solution: 1-2 drops every 2-3 h for 1 wk
B35
B53,54
B36-38
A34,39,40
B55
A37,38,41,42
A27,30,43,44
A56,57
A58,59
B45
B22
Combination drops
Trimethoprim/polymyxin B: 1 or 2 drops
4 ×/d for 1 wk
JAMA October 23/30, 2013 Volume 310, Number 16
Hyperacute
bacterial
13年10月24日木曜日
NA
Purulent
Neisseria gonorrhoeae
A22,40,46
Ceftriaxone: 1 g IM once
C16,47
Lavage of the infected eye
C16
jama.com

18. •
薬剤, 化学, 毒性結膜炎
•
抗生剤点眼, 抗ウイルス薬点眼, 潤滑性点眼薬は,
塩化ベンザルコニウムが含まれており,
それによるアレルギー性結膜炎を来すことがある.
•
結膜炎を来す全身疾患
•
Mucous membrane pemphigoid, Sjogren syndrome, 川崎病,
Stevens-Johnson syndrome, Carotid cavernous fistulaで結膜炎を来す.
•
軽症の頸動脈-静脈洞瘻では慢性の結膜炎のみ呈することがある.
13年10月24日木曜日

19. •
抗生剤/ステロイド合剤点眼 不使用ノススメ
•
アデノウイルスによる結膜炎にステロイドを使用することで,
感染が長期化するリスクがあがる.
•
また, 角膜潰瘍を見逃した状態でステロイド点眼を使用すると,
ステロイドにより角膜が溶解し失明に至る可能性もあるため,
容易に抗生剤/ステロイド合剤は使用すべきでない.
13年10月24日木曜日