Acute conjunctivitis

Last reviewed: 19 Apr 2022
Last updated: 18 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • watery discharge
  • ropy, mucoid discharge
  • purulent discharge
  • itching predominant symptom
  • red eye
  • eyelids stuck together in morning
  • tender, pre-auricular lymphadenopathy
More key diagnostic factors

Other diagnostic factors

  • conjunctival follicles
  • chemosis
  • swollen eyelids
  • superficial punctate keratopathy
  • unilateral symptoms and signs
  • use of medications that may lead to eye irritation
  • contact lens use
  • corneal subepithelial infiltrates
  • corneal pannus
  • vesicular skin rash
  • symptoms and signs of related systemic disease
Other diagnostic factors

Risk factors

  • exposure to infected person
  • infection in one eye
  • environmental irritants
  • allergen exposure
  • concurrent infection
  • camps, swimming pools, military bases
  • Asian or Mediterranean boy or young man
  • atopic dermatitis
  • contact lens use
  • ocular prosthesis
  • trauma: mechanical, chemical, or ultraviolet
  • recent surgery or exposed sutures
  • hot, dry environment
  • rosacea
  • allogeneic stem cell transplantation
  • Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN)
  • prior infection with herpes simplex virus
  • in neonate: vaginal delivery
  • oculogenital spread
  • asthma
  • hay fever
  • topical eye medicine
  • oral antihistamine/anticholinergic drugs
  • neoplasia
  • history of rheumatological disease
  • dysthyroid states
  • immunocompromised state
  • vasculitis
  • nasolacrimal duct obstruction
  • abnormality of supporting structures of the eye (adnexa)
  • severe tear deficiency
  • trauma
More risk factors

Diagnostic investigations

1st investigations to order

  • rapid adenovirus immunoassay
More 1st investigations to order

Investigations to consider

  • cell culture
  • special stains (Gram, Giemsa)
  • polymerase chain reaction
  • ocular pH
  • allergy skin testing
  • tear immunoglobulin E level
More investigations to consider

Treatment algorithm

ACUTE

allergic conjunctivitis (seasonal/perennial)

bacterial conjunctivitis

chlamydial conjunctivitis (inclusion)

viral conjunctivitis

neonatal conjunctivitis

contact lens related

mechanical conjunctivitis

toxic/chemical conjunctivitis

medicine-related conjunctivitis

Contributors

Authors

Robert Sambursky, MD

Fellowship-Trained Ophthalmologist

Manatee Sarasota Eye Clinic & Laser Center

Bradenton

FL

Disclosures

RS is employed by Lumos Diagnostics and serves on the board of Lumos Diagnostics, Visus Therapeutics, and PPK Solutions.

Acknowledgements

Dr Robert Sambursky would like to gratefully acknowledge Dr Lee Raykovicz, a previous contributor to this topic.

Disclosures

LR is Director of Clinical Relations, Rapid Pathogen Screening, Inc.

Peer reviewers

Michael Ehrenhaus, MD

Director

Cornea, External Disease & Refractive Surgery

Long Island College Hospital Eye Center

Assistant Professor of Ophthalmology

SUNY Downstate Medical Center

Brooklyn

NY

Disclosures

ME declares that he has no competing interests.

Scott Fraser, MD, FRCS (Ed), FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

UK

Disclosures

SF declares that he has no competing interests.

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