CURRENT PRACTICE - DIAGNOSIS AND TREATMENT IN PRIMARY HEALTH-CARE

In a primary healthcare facility, there are certain 'rules of thumb' t hat can be recommended for the diagnosis and treatment of conjunctivit is. The type of discharge is a crucial factor in the differential diag nosis and can also be a clue towards the management in primary care. I t is important to identify whether the conjunctivitis is an isolated c ase or part of another disease, and if it is acute or chronic, and I w ould suggest taking a smear or culture sample whenever possible. When the aetiology is not clear, I would try antibiotics. If the patient is allergic, and an allergic conjunctivitis is suspected, the best manag ement today is to use mast cell stabilisers, and combine these with co nservative measures of frequent washings, and compresses. If the aetio logy remains doubtful, or if there is no obvious improvement using the se treatments, the patient should be re-evaluated and/or referred to a n ophthalmologist or specialist eye centre. The use of corticosteroids for conjunctivitis should certainly be avoided in primary healthcare. Conjunctivitis is often self-limited and the drug-induced consequence s of improper management can be far more devastating than the disease itself.