Conjunctivitis resident survival guide: Difference between revisions

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{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Conjunctivitis Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Diagnosis|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Differential Diagnosis|Differential Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Do's|Do's]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Conjunctivitis resident survival guide#Don'ts|Don'ts]]
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{{WikiDoc CMG}}; {{AE}}
 
{{WikiDoc CMG}}; {{AE}} {{Arash.M}}


==Overview==
==Overview==
[[Conjunctivitis]] is the most common [[eye infection]] causing dilation of [[conjunctival]] blood vessels and results in [[inflammation]]. 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]] can be presented with [[red eye]], [[foreign body sensation]], [[itching]], [[light sensitivity]], burning, and [[watery discharge]] in [[viral conjunctivitis]] and [[mucopurulent discharge]] in [[bacterial]] form. 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.
[[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==
==Causes==
===Life Threatening 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:<ref name="pmid22348418">{{cite journal| author=Epling J| title=Bacterial conjunctivitis. | journal=BMJ Clin Evid | year= 2012 | volume= 2012 | issue=  | pages=  | pmid=22348418 | doi= | pmc=3635545 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22348418  }} </ref>
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:<ref name="pmid22348418">{{cite journal| author=Epling J| title=Bacterial conjunctivitis. | journal=BMJ Clin Evid | year= 2012 | volume= 2012 | issue=  | pages=  | pmid=22348418 | doi= | pmc=3635545 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22348418  }} </ref>
* [[keratitis]]
* [[keratoconjunctivitis]]


*[[keratitis]] - which occurs mostly on [[Contact lens|contact-lens]] wearers
*[[keratoconjunctivitis]]
*[[Scarring of the eye]] - especially associated with [[trachoma]]<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
*[[Uveitis]] - especially associated with [[herpes simplex virus]]<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>


===Viral conjunctivitis===
===Viral conjunctivitis===
* [[Adenoviruses]] are the most common cause of [[viral conjunctivitis]]<ref name="pmid32210533">{{cite journal| author=Yeu E, Hauswirth S| title=A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management. | journal=Clin Ophthalmol | year= 2020 | volume= 14 | issue=  | pages= 805-813 | pmid=32210533 | doi=10.2147/OPTH.S236571 | pmc=7075432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32210533  }} </ref>  
 
* [[Herpes simplex virus]] ([[HSV]])
*[[Adenoviruses]] are the most common cause of [[viral conjunctivitis]]<ref name="pmid32210533">{{cite journal| author=Yeu E, Hauswirth S| title=A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management. | journal=Clin Ophthalmol | year= 2020 | volume= 14 | issue=  | pages= 805-813 | pmid=32210533 | doi=10.2147/OPTH.S236571 | pmc=7075432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32210533  }} </ref>
* [[Varicella zoster virus]] ([[VZV]])
*[[Herpes simplex virus]] ([[HSV]])
* [[Picornaviruses]]  
*[[Varicella zoster virus]] ([[VZV]])
*[[Picornaviruses]]<ref name="pmid173388">{{cite journal| author=Chaturvedi UC, Mathur A, Singh UK, Kapoor AK, Mehrotra RM, Saxena RC| title=An epidemic of picornavirus and adenovirus conjunctivitis. | journal=Br J Ophthalmol | year= 1975 | volume= 59 | issue= 8 | pages= 439-43 | pmid=173388 | doi=10.1136/bjo.59.8.439 | pmc=1017389 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=173388  }} </ref>


===Bacterial conjunctivitis===
===Bacterial conjunctivitis===
* [[Staphylococcus aureus]]<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
 
* [[Haemophilus influenza]]
*[[Staphylococcus aureus]]<ref name="pmid32864068">{{cite journal| author=Azari AA, Arabi A| title=Conjunctivitis: A Systematic Review. | journal=J Ophthalmic Vis Res | year= 2020 | volume= 15 | issue= 3 | pages= 372-395 | pmid=32864068 | doi=10.18502/jovr.v15i3.7456 | pmc=7431717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32864068  }} </ref>
* [[Streptococcus pneumoniae]]
*[[Haemophilus influenza]]
* [[Moraxella catarrhalis]]
*[[Streptococcus pneumoniae]]
*[[Moraxella catarrhalis]]


==Diagnosis==
==Diagnosis==
Some initial diagnosis should be excluded for which physicians should manage patients by a systematic approach.<ref name="VaruRhee2019">{{cite journal|last1=Varu|first1=Divya M.|last2=Rhee|first2=Michelle K.|last3=Akpek|first3=Esen K.|last4=Amescua|first4=Guillermo|last5=Farid|first5=Marjan|last6=Garcia-Ferrer|first6=Francisco J.|last7=Lin|first7=Amy|last8=Musch|first8=David C.|last9=Mah|first9=Francis S.|last10=Dunn|first10=Steven P.|title=Conjunctivitis Preferred Practice Pattern®|journal=Ophthalmology|volume=126|issue=1|year=2019|pages=P94–P169|issn=01616420|doi=10.1016/j.ophtha.2018.10.020}}</ref>
Some initial diagnosis should be excluded for which physicians should manage patients by a systematic approach.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: center; width: 14em; padding:1em;"> Suspected [[acute conjunctivitis]] <br>(<4 weeks duration) </div>}}
{{familytree | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: center; width: 14em; padding:1em;"> Suspected [[acute conjunctivitis]] <br>(<4 weeks duration) </div>}}
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{{familytree/end}}
{{familytree/end}}


===Differential diagnosis===
===Differential Diagnosis===


{| class="sortable" border="1" cellpadding="5" cellspacing="0" align="center" style="text-align:center;"
{| class="sortable" border="1" cellpadding="5" cellspacing="0" align="center" style="text-align:center;"
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|-
   !Differentail diagnosis
   !Differential diagnosis
   !Manifestation
   !Manifestation
   !Examination findings
   !Examination findings
|-
|-
   |[[Blepharitis]]<ref name="AmescuaAkpek2019">{{cite journal|last1=Amescua|first1=Guillermo|last2=Akpek|first2=Esen K.|last3=Farid|first3=Marjan|last4=Garcia-Ferrer|first4=Francisco J.|last5=Lin|first5=Amy|last6=Rhee|first6=Michelle K.|last7=Varu|first7=Divya M.|last8=Musch|first8=David C.|last9=Dunn|first9=Steven P.|last10=Mah|first10=Francis S.|title=Blepharitis Preferred Practice Pattern®|journal=Ophthalmology|volume=126|issue=1|year=2019|pages=P56–P93|issn=01616420|doi=10.1016/j.ophtha.2018.10.019}}</ref>
   |'''[[Blepharitis]]'''
   |Burning and foreign-body sensation, symptoms worse with prolonged reading or watching
  |
  |[[Bilateral redness]]
*Burning and foreign-body sensation, [[Symptom|symptoms]] worse with prolonged reading or watching<ref name="AmescuaAkpek2019">{{cite journal|last1=Amescua|first1=Guillermo|last2=Akpek|first2=Esen K.|last3=Farid|first3=Marjan|last4=Garcia-Ferrer|first4=Francisco J.|last5=Lin|first5=Amy|last6=Rhee|first6=Michelle K.|last7=Varu|first7=Divya M.|last8=Musch|first8=David C.|last9=Dunn|first9=Steven P.|last10=Mah|first10=Francis S.|title=Blepharitis Preferred Practice Pattern®|journal=Ophthalmology|volume=126|issue=1|year=2019|pages=P56–P93|issn=01616420|doi=10.1016/j.ophtha.2018.10.019}}</ref>
   |
*[[Bilateral redness]]
|-
|-
   |[[Uveitis]]<ref name="pmid30214346">{{cite journal| author=Harthan JS, Opitz DL, Fromstein SR, Morettin CE| title=Diagnosis and treatment of anterior uveitis: optometric management. | journal=Clin Optom (Auckl) | year= 2016 | volume= 8 | issue=  | pages= 23-35 | pmid=30214346 | doi=10.2147/OPTO.S72079 | pmc=6095364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30214346  }} </ref>
   |'''[[Uveitis]]'''
  |[[Photophobia]], pain, [[blurred vision]]
  |
   |Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, [[red eye]]
*[[Photophobia]], pain, [[blurred vision|blurred vision<ref name="pmid30214346">{{cite journal| author=Harthan JS, Opitz DL, Fromstein SR, Morettin CE| title=Diagnosis and treatment of anterior uveitis: optometric management. | journal=Clin Optom (Auckl) | year= 2016 | volume= 8 | issue=  | pages= 23-35 | pmid=30214346 | doi=10.2147/OPTO.S72079 | pmc=6095364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30214346  }} </ref>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid30214346-7|<span class="mw-reflink-text">[7]</span>]]
   |
*Decreased vision, poorly reacting [[pupils]], constant eye pain radiating to temple and brow, [[Red eye|red-eye]]
|-
|-
   |[[Angle closure glaucoma]]<ref name="pmid24825645">{{cite journal| author=Weinreb RN, Aung T, Medeiros FA| title=The pathophysiology and treatment of glaucoma: a review. | journal=JAMA | year= 2014 | volume= 311 | issue= 18 | pages= 1901-11 | pmid=24825645 | doi=10.1001/jama.2014.3192 | pmc=4523637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24825645  }} </ref>
   |'''[[Angle closure glaucoma]]'''
  |Headache, [[nausea]], [[vomiting]], ocular pain, decreased vision, light sensitivity
  |
   |Firm eye on palpation, [[ocular]] redness, steamy [[cornea]]
*[[Headache]], [[nausea]], [[vomiting]], [[ocular]] pain, decreased [[vision]], [[light sensitivity|light sensitivity<ref name="pmid24825645">{{cite journal| author=Weinreb RN, Aung T, Medeiros FA| title=The pathophysiology and treatment of glaucoma: a review. | journal=JAMA | year= 2014 | volume= 311 | issue= 18 | pages= 1901-11 | pmid=24825645 | doi=10.1001/jama.2014.3192 | pmc=4523637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24825645  }} </ref>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid24825645-8|<span class="mw-reflink-text">[8]</span>]]
   |
*Firm eye on [[palpation]], [[ocular]] redness, steamy [[cornea]]
|-
|-
   |[[Endophthalmitis]]<ref name="pmid11781270">{{cite journal| author=Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS| title=Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 1 | pages= 111-24 | pmid=11781270 | doi=10.1128/cmr.15.1.111-124.2002 | pmc=118063 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11781270  }} </ref>
   |'''[[Endophthalmitis|Endophthalmitis]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]]'''
  |Severe pain, [[photophobia]]
  |
   |[[Red eye]], pus in the [[anterior chamber]], history of eye surgery or [[ocular trauma]]
*Severe pain, [[photophobia]][[Endophthalmitis|<ref name="pmid11781270">{{cite journal| author=Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS| title=Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 1 | pages= 111-24 | pmid=11781270 | doi=10.1128/cmr.15.1.111-124.2002 | pmc=118063 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11781270  }} </ref>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid11781270-9|<span class="mw-reflink-text">[9]</span>]]<span class="mw-reflink-text"><nowiki>[9]</nowiki></span>
   |
*Red-eye, [[pus]] in the [[anterior chamber]], history of eye surgery or [[ocular trauma]]
|-
|-
   |[[Scleritis]]<ref name="pmid26682176">{{cite journal| author=Al Barqi M, Behrens A, Alfawaz AM| title=Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia. | journal=Int J Ophthalmol | year= 2015 | volume= 8 | issue= 6 | pages= 1215-9 | pmid=26682176 | doi=10.3980/j.issn.2222-3959.2015.06.25 | pmc=4651892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26682176  }} </ref>
   |'''[[Scleritis]]'''
   |Decreased vision, moderate to severe pain
  |
  |Redness, bluish [[sclera]]  
*Decreased [[vision]], moderate to severe pain<ref name="pmid26682176">{{cite journal| author=Al Barqi M, Behrens A, Alfawaz AM| title=Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia. | journal=Int J Ophthalmol | year= 2015 | volume= 8 | issue= 6 | pages= 1215-9 | pmid=26682176 | doi=10.3980/j.issn.2222-3959.2015.06.25 | pmc=4651892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26682176  }} </ref>
   |
*Redness, bluish [[sclera]]
|-
|-
   |[[Subconjunctival hemorrhage]]<ref name="pmid23843690">{{cite journal| author=Tarlan B, Kiratli H| title=Subconjunctival hemorrhage: risk factors and potential indicators. | journal=Clin Ophthalmol | year= 2013 | volume= 7 | issue=  | pages= 1163-70 | pmid=23843690 | doi=10.2147/OPTH.S35062 | pmc=3702240 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843690  }} </ref>
   |'''[[Subconjunctival hemorrhage]]'''
  |foreign-body sensation and tearing or be asymptomatic
  |
   |Blood under the [[conjunctival]] membrane
*Foreign-body sensation and tearing or be [[asymptomatic|asymptomatic<ref name="pmid23843690">{{cite journal| author=Tarlan B, Kiratli H| title=Subconjunctival hemorrhage: risk factors and potential indicators. | journal=Clin Ophthalmol | year= 2013 | volume= 7 | issue=  | pages= 1163-70 | pmid=23843690 | doi=10.2147/OPTH.S35062 | pmc=3702240 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843690  }} </ref>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]][[Conjunctivitis resident survival guide#cite%20note-pmid23843690-11|<span class="mw-reflink-text">[11]</span>]]
   |
*Blood under the [[conjunctival]] membrane
|-
|-
|'''[[Corneal abrasion]]'''
  |
*Red-eye, pain, [[foreign-body]] sensation and tearing<ref name="pmid22348418" />
  |
*If caused by a [[foreign-body]], it can be found on biomicroscopic exam
|}
|}


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
 
{{familytree/start |summary=PE diagnosis Algorithm.}}
{| class="wikitable"
{{familytree | | | | | | | | A01 |A01= }}
|+Medical therapy for conjunctivitis<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Category }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Epidemiology }}
{{familytree | | | |!| | | | | | | | | |!| }}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Type of discharge }}
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Cause }}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Treatment }}
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
|-
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
|[[Viral conjunctivitis|'''Viral conjunctivitis''']]
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
|
{{familytree | | | | | | | | | | |!| | | | |!| }}
*80% of all [[acute conjunctivitis]]
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
|
{{familytree/end}}
*[[Serous]]
|
*[[Adenovirus]] in 65% of cases
|
*Cold compress<br>
 
*[[Artificial tears]]
 
*[[Antihistamines]]
|-
|'''[[HSV]]'''
|
*1.3-4.8% of all [[acute conjunctivitis]]
|
*Variable
|
*[[Herpes simplex virus]]
|
*Topical [[acyclovir]] 1 drop 9x per day for 7-10 days
|-
|'''Acute [[bacterial conjunctivitis]]'''
|
*18.3%-57% of all [[acute conjunctivitis]]
|
*[[Mucopurulent]]
|
*[[Staphylococcus aureus]]
*Staphylococcus epidermidis
 
*Haemophilus influenzae
*Streptococcus pneumoniae
|
*[[Aminoglycosides]]
**[[Gentamicin]]
 
*Ointment: qid for 1 wk
*Solution: 1-2 drops qid for 1 week<br>[[Fluoroquinolones]]
 
*[[Ciprofloxacin]]
 
*Ointment: Tid (three times a day) for 1 wk
*Solution: 1-2 drops Qid (four times a day) for 1 week
|-
|[[Allergic conjunctivitis|'''Allergic conjunctivitis''']]
|
*Up to 40% of the population may be affected
|
*Serous or mucoid
|
*[[Pollen]]
|
*Topical [[antihistamines]]
**[[Azelastine]] 0.05%: 1 drop bid
 
*Topical [[mast cell]] inhibitors
**[[Cromolyn sodium]] 4%: 1-2 drops every 4-6 h
|}


==Do's==
==Do's==
* The content in this section is in bullet points.
 
*In assessment of a person presenting with [[red eye]], serious causes (such as [[acute glaucoma]], [[keratitis]], [[iritis]] and [[trauma]]) must be excluded.<ref name="pmid15186569">{{cite journal| author=Owen CG, Shah A, Henshaw K, Smeeth L, Sheikh A| title=Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness. | journal=Br J Gen Pract | year= 2004 | volume= 54 | issue= 503 | pages= 451-6 | pmid=15186569 | doi= | pmc=1266207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15186569  }} </ref><ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref>
*Urgent referral to [[ophthalmology]] should be arranged if the person has:
**A red flag indicating a serious cause of [[red eye]]
**Suspected [[gonococcal]] or [[chlamydial conjunctivitis]]
**Suspected [[periorbital]] or [[orbital cellulitis]]
**Had recent [[intraocular]] surgery
**[[Conjunctivitis]] associated with a severe systemic condition or is [[immunocompromised]]
**[[Corneal]] involvement
**Possible [[herpes infection]]
*Reassuring the person that most cases are self-limiting
*Advising self-care measures such as cleaning the [[eyelids]], cool compresses, [[lubricating drops]] or [[artificial tears]] and avoidance of [[contact lenses]]
*In most cases of [[bacterial conjunctivitis]], observation can be the only option because they often resolve spontaneously and no treatment is necessary. However, using [[topical]] [[antibiotics]] is are effective in reducing the duration of [[conjunctivitis]]
*[[Topical antihistamines]] and [[mast cell stabilizers]] in [[allergic conjunctivitis]] is recommended
*In cases of severely [[purulent conjunctivitis]] or chronic [[conjunctivitis]] [[bacterial culture]] is useful


==Don'ts==
==Don'ts==
* The content in this section is in bullet points.
 
*People with weaker immune systems such as those with [[diabetes]] and people who don’t wash their hands before inserting or removing [[contact lenses]] are more at risk of [[bacterial conjunctivitis]].<ref name="pmid18646586">{{cite journal| author=Tarabishy AB, Jeng BH| title=Bacterial conjunctivitis: a review for internists. | journal=Cleve Clin J Med | year= 2008 | volume= 75 | issue= 7 | pages= 507-12 | pmid=18646586 | doi=10.3949/ccjm.75.7.507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18646586  }} </ref>
*Patients with any form of [[conjunctivitis]] should refrain from wearing [[contact lenses]] until the [[conjunctivitis]] has completely cleared up.
*Both types of [[ infectious conjunctivitis]] are very [[contagious]] and easily spread. It is important to avoid contacting others or sharing equipment with other people to help prevent spreading the [[infection]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 21:10, 8 January 2021

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.