Objective: To determine the prevalence, incidence, and etiology of conjunctivitis in residents of a long-term care facility.
Design: Prospective surveillance of episodes of conjunctivitis during two 6-month periods.
Setting: Three-building, 319-bed, multipurpose, long-term care facility including units for personal care, chronic care, palliative care, rehabilitation, respiratory rehabilitation, and chronic ventilator patients.
Results: The incidence of conjunctivitis on different units varied from 0.6 to 3.5 per 1,000 patient-days. One building had a significantly higher rate of acute conjunctivitis and, within that facility, the most highly impaired patients had significantly more disease. Patients with chronic conjunctivitis generally were admitted with conjunctivitis; institutionally acquired conjunctivitis proceeding to chronic conjunctivitis seldom was observed except on the chronic ventilator unit. Residents with chronic conjunctivitis were significantly more likely to have a diagnosis of glaucoma, ectropion, or entropion. Potential bacterial pathogens were isolated from 3 (21%) of 14 and 24 (38%) of 69 acute episodes for which cultures were available in the two study periods. Staphylococcus aureus was the most frequent pathogen isolated. Empiric therapy was usually with topical sodium sulamyd or gentamicin, with substantial interphysician variability in prescribing patterns. Symptom duration did not differ for episodes which did or did not receive topical antimicrobials.
Conclusion: Conjunctivitis is common in this facility and occurs with increased frequency in more highly impaired residents. Most episodes may not be due to bacterial infection. Further study of optimal management approaches to conjunctivitis is necessary.