Acute conjunctivitis
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 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
- 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 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 rheumatologic disease
- dysthyroid states
- immunocompromised state
- vasculitis
- nasolacrimal duct obstruction
- abnormality of supporting structures of the eye (adnexa)
- severe tear deficiency
- trauma
- use of biologic 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
Divulgaciones
ME declares that he has no competing interests.
Scott Fraser, MD, FRCS (Ed), FRCOphth
Consultant Ophthalmologist
Sunderland Eye Infirmary
Sunderland
UK
Divulgaciones
SF declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Cheung, Albert Y. et al. Conjunctivitis preferred practice pattern. Ophthalmology. 2024 Feb 12;131(4): 134-204.Texto completo
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.Texto completo Resumen
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.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Dry eyes
- Blepharitis
- Episcleritis
Más DiferencialesGuías de práctica clínica
- Conjunctivitis preferred practice pattern
- Cornea/external disease summary benchmarks
Más Guías de práctica clínicaFolletos para el paciente
Conjunctivitis
Más Folletos para el paciente
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad