Conjunctivitis resident survival guide

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

Overview[edit | edit source]

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[edit | edit source]

Life Threatening Causes[edit | edit source]

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]

• keratitis - which occurs mostly on contact-lens wearers
• keratoconjunctivitis
• Scarring of the eye - especially associated with trachoma^[2]
• Uveitis - especially associated with herpes simplex virus^[2]

Viral conjunctivitis[edit | edit source]

• Adenoviruses are the most common cause of viral conjunctivitis^[3]
• Herpes simplex virus (HSV)
• Varicella zoster virus (VZV)
• Picornaviruses^[4]

Bacterial conjunctivitis[edit | edit source]

• Staphylococcus aureus^[2]
• Haemophilus influenza
• Streptococcus pneumoniae
• Moraxella catarrhalis

Diagnosis[edit | edit source]

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

Differential Diagnosis[edit | edit source]

Treatment[edit | edit source]

Do's[edit | edit source]

• In assessment of a person presenting with red eye, serious causes (such as acute glaucoma, keratitis, iritis and trauma) must be excluded.^[12][13]
• 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[edit | edit source]

• 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.^[14]
• 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[edit | edit source]