Summary
Definition
Conjunctivitis is the inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunologic reactions, mechanical irritation, or medications.[1][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
- watery discharge
- ropy, mucoid discharge
- purulent discharge
- itching predominant symptom
- red eye
- eyelids stuck together in morning
- tender, preauricular lymphadenopathy
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
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 medication
- oral antihistamine/anticholinergic drugs
- neoplasia
- history of rheumatologic disease
- dysthyroid states
- immunocompromised state
- vasculitis
- nasolacrimal duct obstruction
- abnormality of supporting structures of the eye (adnexa)
- severe tear deficiency
- trauma
Diagnostic investigations
1st investigations to order
- rapid adenovirus immunoassay
Investigations to consider
- cell culture
- special stains (Gram, Giemsa)
- polymerase chain reaction
- 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
medication-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.
Differentials
- Dry eyes
- Blepharitis
- Episcleritis
More DifferentialsGuidelines
- Preferred practice pattern: conjunctivitis
More GuidelinesPatient leaflets
Conjunctivitis
More Patient leaflets
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