II. Symptoms

  1. Eye Discharge
    1. Bacterial Conjunctivitis: Mucoid, purulent discharge
    2. Viral Conjunctivitis: Watery discharge
    3. Allergic Conjunctivitis: Mucoid discharge
  2. Eye Pain minimal
    1. Scratchy foreign body Sensation
    2. Worse pain in Corneal Injury, Iritis, Keratitis and Acute Angle-Closure Glaucoma
  3. Photophobia minimal
    1. Worse in acute Iritis or Keratitis

III. Signs

  1. Conjunctiva erythema
    1. Palpebral Conjunctiva injection
    2. Diffuse erythema over bulbar Conjunctiva
  2. Cornea normal
    1. Epithelial defect in Corneal Injury or diffuse uptake in Keratitis
      1. Fluorescein stain
    2. Diffusely cloudy in acute Glaucoma
  3. Visual Acuity normal
    1. Vision blurred in acute Iritis and Corneal Injury
    2. Vision markedly reduced (<20/200) in acute Glaucoma
  4. Pupil size and reactivity normal
    1. Small pupil in Corneal Injury or Iritis
    2. Dilated non-reactive pupil in Glaucoma
  5. Intraocular Pressure normal
    1. Elevated in acute Glaucoma
  6. No Ciliary Flush
    1. Contrast with Iritis and Glaucoma
  7. Preauricular Lymphadenopathy
    1. Seen in Viral Conjunctivitis (not in Bacterial)

V. Causes: Common

  1. Infectious
    1. Viral Conjunctivitis (esp. Adenovirus)
    2. Bacterial Conjunctivitis
  2. Non-Infectious
    1. Allergic
    2. Dry Eye
    3. Toxic or Chemical Reaction
    4. Contact Lens use
    5. Occult Conjunctival neoplasm
    6. Foreign body
    7. Factitious
    8. Idiopathic

VI. Causes: Serious Conditions to Exclude

  1. Herpes Simplex Conjunctivitis
    1. Unilateral Conjunctival/Corneal Inflammation with severe pain
    2. Concurrent Cold Sores may be present
    3. Dendritic Ulcers on Fluorescein staining of Cornea
  2. Herpes Zoster
    1. See Herpes Ophthalmicus
    2. Observe for Herpes Zoster lesions in the V1 or V2 distribution
    3. Hutchinson sign (Vesicles on the tip of the nose)
  3. Chlamydial Conjunctivitis
    1. Unilateral Conjunctivitis with hyperemia and mucopurulent discharge
    2. May present as subacute case (>4 weeks)
    3. Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
      1. Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva
  4. Gonococcal Conjunctivitis (Hyperacute Bacterial Conjunctivitis)
    1. Severe purulent Eye Discharge, Eye Pain and decreased Vision
    2. Risk of Corneal involvement including Corneal Ulceration
    3. Obtain cultures and treat systemically for both Gonorrhea and Chlamydia

VII. Labs

  1. Eye Gram Stain and culture indications
    1. Corneal Ulceration
    2. Orbital Cellulitis
    3. Severe recurrent or refractory eye infection
  2. Other testing to consider
    1. Chlamydia PCR
    2. Giemsa Stain and viral culture for herpes

IX. Management: Ophthalmology Referral Indications (typically at one week)

  1. Contact Lens users
  2. Topical Corticosteroids required
  3. Photophobia
  4. No improvement after 7 days

X. Resources (Include Patient Education)

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