II. Symptoms
-
Eye Discharge
- Bacterial Conjunctivitis: Mucoid, purulent discharge
- Viral Conjunctivitis: Watery discharge
- Allergic Conjunctivitis: Mucoid discharge
-
Eye Pain minimal
- Scratchy foreign body Sensation
- Worse pain in Corneal Injury, Iritis, Keratitis and Acute Angle-Closure Glaucoma
- Photophobia minimal
III. Signs
-
Conjunctiva erythema
- Palpebral Conjunctiva injection
- Diffuse erythema over bulbar Conjunctiva
-
Cornea normal
- Epithelial defect in Corneal Injury or diffuse uptake in Keratitis
- Fluorescein stain
- Diffusely cloudy in acute Glaucoma
- Epithelial defect in Corneal Injury or diffuse uptake in Keratitis
-
Visual Acuity normal
- Vision blurred in acute Iritis and Corneal Injury
- Vision markedly reduced (<20/200) in acute Glaucoma
-
Pupil size and reactivity normal
- Small pupil in Corneal Injury or Iritis
- Dilated non-reactive pupil in Glaucoma
-
Intraocular Pressure normal
- Elevated in acute Glaucoma
- No Ciliary Flush
-
Preauricular Lymphadenopathy
- Seen in Viral Conjunctivitis (not in Bacterial)
IV. Differential Diagnosis: Red Eye
- Keratitis
- Episcleritis
- Uveitis
- Acute Iritis
- Scleritis
- Narrow Angle Glaucoma
- Subconjunctival Hemorrhage
- Mucous membrane Pemphigoid
- Sjogren Syndrome
- Kawasaki Disease
- Stevens-Johnson Syndrome
- Carotid Cavernous Fistula
V. Causes: Common
- Infectious
- Non-Infectious
- Allergic
- Dry Eye
- Toxic or Chemical Reaction
- Contact Lens use
- Occult Conjunctival neoplasm
- Foreign body
- Factitious
- Idiopathic
VI. Causes: Serious Conditions to Exclude
-
Herpes Simplex Conjunctivitis
- Unilateral Conjunctival/Corneal Inflammation with severe pain
- Concurrent Cold Sores may be present
- Dendritic Ulcers on Fluorescein staining of Cornea
-
Herpes Zoster
- See Herpes Ophthalmicus
- Observe for Herpes Zoster lesions in the V1 or V2 distribution
- Hutchinson sign (Vesicles on the tip of the nose)
-
Chlamydial Conjunctivitis
- Unilateral Conjunctivitis with hyperemia and mucopurulent discharge
- May present as subacute case (>4 weeks)
-
Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
- Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva
-
Gonococcal Conjunctivitis (Hyperacute Bacterial Conjunctivitis)
- Severe purulent Eye Discharge, Eye Pain and decreased Vision
- Risk of Corneal involvement including Corneal Ulceration
- Obtain cultures and treat systemically for both Gonorrhea and Chlamydia
VII. Labs
- Eye Gram Stain and culture indications
- Corneal Ulceration
- Orbital Cellulitis
- Severe recurrent or refractory eye infection
- Other testing to consider
- Chlamydia PCR
- Giemsa Stain and viral culture for herpes
VIII. Management
- See Specific management protocols
- See Viral Conjunctivitis
- See Epidemic Keratoconjunctivitis
- See Bacterial Conjunctivitis
- See Allergic Conjunctivitis
- See Gonococcal Conjunctivitis
- See Herpes Simplex Keratitis
- See Vernal Conjunctivitis
IX. Management: Ophthalmology Referral Indications (typically at one week)
- Contact Lens users
- Topical Corticosteroids required
- Photophobia
- No improvement after 7 days