E. Clean discharge using cotton wool soaked in water – Explanation

There has been a long debate regarding the use of topical antibiotics in bacterial
conjunctivitis. NHS has been moving towards using self care rather than antibiotics for
infective conjunctivitis. For most people, use of a topical ocular antibiotic makes little
difference to recovery from infective conjunctivitis and up to 10% of people treated with
topical ocular antibiotic makes little difference to recovery from infective conjunctivitis
and up to 10% of people treated with topical ocular antibiotics complain of adverse
reactions to treatment. Not to mention, that the risk of a serious complication from
untreated infective conjunctivitis is low.
Thus, one should only consider topical ocular antibiotics if the infective conjunctivitis is
severe, or likely to become severe, providing serious causes of a red eye can
confidently excluded. It would seem reasonable to consider infective conjunctivitis to be
severe when the person considers the symptoms to be distressing or signs are judged
to be severe from clinical experience. However, it is obvious that you will not be able to
tell based on the PLAB questions if it is severe conjunctivitis or mild conjunctivitis. So a
good guideline that you should follow is based on time. If the patient has infective
conjunctivitis for more than 7 days, then start the patient on topical antibiotics. If it is
less than 7 days, then choose the option that has self-care rather than topical
antibiotics.
Topical steroids is always going to be the wrong answer unless it is herpes simplex
virus conjunctivitis. It is only used if keratitis extends deep into the stoma.
Bacterial conjunctivitis management

• Most cases of infective conjunctivitis do not need medical treatment and clear up in
  one to two weeks.

• Gently clean away sticky discharge from your eyelids and lashes using cotton wool
  soaked in water.
• If the decision is made to use antibiotics → chloramphenicol drops is the drug of
  choice. Chloramphenicol has a broad spectrum of activity and is the drug of choice
  for superficial eye infections. It is bacteriostatic, with a relatively broad spectrum of
  action against most Gram-positive and Gram-negative bacteria.

Types of conjunctivitis: