Summary
Definition
Conjunctivitis is the inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation, or drugs.[Figure caption and citation for the preceding image starts]: Viral conjunctivitisFrom the collection of Robert Sambursky, MD; used with permission [Citation ends].
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
Other diagnostic factors
- conjunctival follicles
- chemosis
- swollen eyelids
- superficial punctate keratopathy
- unilateral symptoms and signs
- use of drugs that may lead to eye irritation
- contact lens use
- corneal subepithelial infiltrates
- corneal pannus
- vesicular skin rash
- symptoms and signs of related systemic disease
Risk factors
- exposure to infected person
- infection in one eye
- environmental irritants
- allergen exposure
- concurrent infection
- camps, swimming pools, military bases
- hot, dry climate
- atopic dermatitis
- contact lens use
- ocular prosthesis
- trauma: mechanical, chemical, or ultraviolet
- recent surgery or exposed sutures
- 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
- use of topical eye preparations
- use of oral antihistamines or 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
- use of biological agents
Diagnostic tests
1st tests to order
- rapid adenovirus immunoassay
Tests to consider
- conjunctival cultures
- special stains (Gram, Giemsa)
- polymerase chain reaction (PCR)
- ocular pH
- allergy skin testing
- tear immunoglobulin E level
Treatment algorithm
allergic conjunctivitis (seasonal/perennial)
bacterial conjunctivitis
chlamydial conjunctivitis (inclusion)
viral conjunctivitis
neonatal conjunctivitis
contact lens related
mechanical conjunctivitis
toxic/chemical conjunctivitis
drug-related conjunctivitis
Contributors
Authors
Christopher McStay, MD
Associate Professor of Emergency Medicine
Vice Chair of Clinical Operations
Columbia University Vagelos College of Physicians and Surgeons
New York
NY
Disclosures
CM declares that he has no competing interests.
Acknowledgements
Dr Christopher McStay would like to gratefully acknowledge Dr Lee Raykovicz and Dr Robert Sambursky, previous contributors to this topic.
Disclosures
LR declared he was Director of Clinical Relations, Rapid Pathogen Screening, Inc. RS is employed by Verséa Ophthalmics and serves on the board of Visus Therapeutics.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Cheung, Albert Y. et al. Conjunctivitis preferred practice pattern. Ophthalmology. 2024 Feb 12;131(4): 134-204.Full text
Castillo M, Scott NW, Mustafa MZ, et al. Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis. Cochrane Database Syst Rev. 2015 Jun 1;(6):CD009566.Full text Abstract
Chen YY, Liu SH, Nurmatov U, et al. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2023 Mar 13;3(3):CD001211.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dry eyes
- Blepharitis
- Episcleritis
More DifferentialsGuidelines
- Conjunctivitis preferred practice pattern
- Cornea/external disease summary benchmarks
More GuidelinesPatient information
Conjunctivitis
More Patient information
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