Conjunctivitis

Aka: Conjunctivitis

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)

IV. Differential Diagnosis: Red Eye

  1. Keratitis
  2. Episcleritis
  3. Uveitis
  4. Acute Iritis
  5. Scleritis
  6. Narrow Angle Glaucoma
  7. Subconjunctival Hemorrhage
  8. Mucous membrane Pemphigoid
  9. Sjogren Syndrome
  10. Kawasaki Disease
  11. Stevens-Johnson Syndrome
  12. Carotid Cavernous Fistula

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

VIII. Management

  1. See Specific management protocols
  2. See Viral Conjunctivitis
  3. See Epidemic Keratoconjunctivitis
  4. See Bacterial Conjunctivitis
  5. See Allergic Conjunctivitis
  6. See Gonococcal Conjunctivitis
  7. See Herpes Simplex Keratitis
  8. See Vernal Conjunctivitis

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)

  1. See Conjunctivitis Resources

XI. References

  1. Azari (2013) JAMA 310:1721-9 [PubMed]
  2. Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]

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Related Studies

Ontology: Conjunctivitis (C0009763)

Definition (NCI) Inflammation of the conjunctiva of the eye.
Definition (NCI_CTCAE) A disorder characterized by inflammation, swelling and redness to the conjunctiva of the eye.
Definition (NCI_NCI-GLOSS) A condition in which the conjunctiva (membranes lining the eyelids and covering the white part of the eye) become inflamed or infected.
Definition (CSP) inflammation of the mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera; also called pinkeye and redeye.
Concepts Disease or Syndrome (T047)
MSH D003231
ICD9 372.30
ICD10 H10 , H10.9
SnomedCT 193857008, 193875009, 193858003, 9826008
LNC MTHU020828
English Conjunctivitides, Conjunctivitis, Conjunctivitis, unspecified, conjunctivitis, conjunctivitis (diagnosis), Unspecified conjunctivitis, Conjunctivitis [Disease/Finding], inflammation of conjunctiva, conjunctiva inflammation, Conjunctivitis NOS, Unspecified conjunctivitis (disorder), Conjunctiva inflamed, CONJUNCTIVITIS, Pink Eye, Inflammation of conjunctiva, Conjunctivitis (disorder), Conjunctivitis, NOS
French CONJONCTIVITE, Conjonctivite, non précisée, Conjonctivite SAI, Conjonctivite
Portuguese CONJUNTIVITE, Conjuntivite NE, Conjuntivite
Spanish CONJUNTIVITIS, Conjuntivitis NEOM, Conjuntivitis no especificada, conjuntivitis no especificada (trastorno), conjuntivitis no especificada, conjuntivitis (trastorno), conjuntivitis, inflamación de la conjuntiva, Conjuntivitis
German KONJUNKTIVITIS, Konjunktivitis NNB, Konjunktivitis, unspezifisch, Konjunktivitis, nicht naeher bezeichnet, Konjunktivits, Konjunktivitis, Augenbindehaut-Entzündung, Bindehautentzündung
Dutch conjunctivitis, niet-gespecificeerd, conjunctivitis NAO, Conjunctivitis, niet gespecificeerd, conjunctivitis, Conjunctivitis
Italian Congiuntivite NAS, Congiuntivite, non specificata, Congiuntivite
Japanese 結膜炎ＮＯＳ, 結膜炎, 結膜炎、詳細不明, ｹﾂﾏｸｴﾝｼｮｳｻｲﾌﾒｲ, ｹﾂﾏｸｴﾝ, ｹﾂﾏｸｴﾝNOS
Swedish Bindhinneinflammation
Czech konjunktivitida, spojivka - zánět, zánět spojivek, Konjunktivitida, Konjunktivitida NOS, Blíže neurčená konjunktivitida
Finnish Sidekalvotulehdus
Russian KON"IUNKTIVIT, КОНЪЮНКТИВИТ
Korean 결막염, 상세불명의 결막염
Croatian KONJUNKTIVITIS
Polish Zapalenie spojówek
Hungarian Kötőhártyagyulladás, Conjunctivitis k.m.n., Kötőhártyagyulladás, nem meghatározott
Norwegian Øyebetennelse, Konjunktivitt, Øyekatarr, Bindehinnebetennelse
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Conjunctival Disorders

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