Conjunctivitis resident survival guide

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Conjunctivitis Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Differential Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Overview

Conjunctivitis is the most common eye infection in which inflammation causes dilation of conjunctival blood vessels giving the eye a reddish aspect. The most common cause of conjunctivitis is infection of which viral infections are the commonest cause, followed by bacterial. The non-infection forms are allergic, mechanical, toxic and neoplastic. Among noninfectious conjunctivitis, the allergic form is more common. Infectious conjunctivitis presents with many similar symptoms regardless of the cause, such as: red eye, foreign body sensation, itching, light sensitivity, burning. Watery discharge is common in viral conjunctivitis while mucopurulent discharge is more suggestive of bacterial cause. Regarding the onset and severity of clinical symptoms, conjunctivitis is classified as acute, chronic, and recurrent. Most cases of infectious conjunctivitis are considered as acute conjunctivitis. Allergic conjunctivitis can be chronic while it can be present with acute exacerbations related to seasonal factors or contact lens use. It is important to differentiate conjunctivitis from other sight-threatening eye diseases that have similar clinical presentation.

Causes

Life Threatening Causes

Most cases of conjunctivitis are relatively mild and will not cause eye damage of any sort. However, if it left untreated it can lead to sight-treathening complications including:[1]

Viral conjunctivitis

Bacterial conjunctivitis

Diagnosis

Some initial diagnosis should be excluded for which physicians should manage patients by a systematic approach.[5]

 
 
 
 
 
 
 
 
Suspected acute conjunctivitis
(<4 weeks duration)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Associated with pain, blurred vision, photophobia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
 
Any discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Itiching
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Differential Diagnosis

Differential diagnosis Manifestation Examination findings
Blepharitis
  • Burning and foreign-body sensation, symptoms worse with prolonged reading or watching[6]
Uveitis
  • Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, red-eye
Angle closure glaucoma
Endophthalmitis[9][9][9]
Scleritis
Subconjunctival hemorrhage
Corneal abrasion
  • If caused by a foreign-body, it can be found on biomicroscopic exam

Treatment

Medical therapy for conjunctivitis[5]
Category Epidemiology Type of discharge Cause Treatment
Viral conjunctivitis
  • Cold compress
HSV
  • Variable
  • Topical acyclovir 1 drop 9x per day for 7-10 days
Acute bacterial conjunctivitis
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Ointment: Tid (three times a day) for 1 wk
  • Solution: 1-2 drops Qid (four times a day) for 1 week
Allergic conjunctivitis
  • Up to 40% of the population may be affected
  • Serous or mucoid

Do's

Don'ts

References

  1. 1.0 1.1 Epling J (2012). "Bacterial conjunctivitis". BMJ Clin Evid. 2012. PMC 3635545. PMID 22348418.
  2. 2.0 2.1 2.2 Azari AA, Arabi A (2020). "Conjunctivitis: A Systematic Review". J Ophthalmic Vis Res. 15 (3): 372–395. doi:10.18502/jovr.v15i3.7456. PMC 7431717 Check |pmc= value (help). PMID 32864068 Check |pmid= value (help).
  3. Yeu E, Hauswirth S (2020). "A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management". Clin Ophthalmol. 14: 805–813. doi:10.2147/OPTH.S236571. PMC 7075432 Check |pmc= value (help). PMID 32210533 Check |pmid= value (help).
  4. Chaturvedi UC, Mathur A, Singh UK, Kapoor AK, Mehrotra RM, Saxena RC (1975). "An epidemic of picornavirus and adenovirus conjunctivitis". Br J Ophthalmol. 59 (8): 439–43. doi:10.1136/bjo.59.8.439. PMC 1017389. PMID 173388.
  5. 5.0 5.1 Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  6. Amescua, Guillermo; Akpek, Esen K.; Farid, Marjan; Garcia-Ferrer, Francisco J.; Lin, Amy; Rhee, Michelle K.; Varu, Divya M.; Musch, David C.; Dunn, Steven P.; Mah, Francis S. (2019). "Blepharitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P56–P93. doi:10.1016/j.ophtha.2018.10.019. ISSN 0161-6420.
  7. Harthan JS, Opitz DL, Fromstein SR, Morettin CE (2016). "Diagnosis and treatment of anterior uveitis: optometric management". Clin Optom (Auckl). 8: 23–35. doi:10.2147/OPTO.S72079. PMC 6095364. PMID 30214346.
  8. Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
  9. Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS (2002). "Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions". Clin Microbiol Rev. 15 (1): 111–24. doi:10.1128/cmr.15.1.111-124.2002. PMC 118063. PMID 11781270.
  10. Al Barqi M, Behrens A, Alfawaz AM (2015). "Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia". Int J Ophthalmol. 8 (6): 1215–9. doi:10.3980/j.issn.2222-3959.2015.06.25. PMC 4651892. PMID 26682176.
  11. Tarlan B, Kiratli H (2013). "Subconjunctival hemorrhage: risk factors and potential indicators". Clin Ophthalmol. 7: 1163–70. doi:10.2147/OPTH.S35062. PMC 3702240. PMID 23843690.
  12. Owen CG, Shah A, Henshaw K, Smeeth L, Sheikh A (2004). "Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness". Br J Gen Pract. 54 (503): 451–6. PMC 1266207. PMID 15186569.
  13. Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  14. Tarabishy AB, Jeng BH (2008). "Bacterial conjunctivitis: a review for internists". Cleve Clin J Med. 75 (7): 507–12. doi:10.3949/ccjm.75.7.507. PMID 18646586.