Conjunctivitis is one of the most common nontraumatic eye complaints resulting in presentation to the office. The term describes any inflammatory process that involves the conjunctiva.
- In classic presentations, patients complain of eyelids sticking together on waking.
- They may describe itching and burning or a gritty foreign-body sensation.
- Pus sliding across the eye may distort vision, though visual acuity is normal.
- Photophobia is minimal.
- Family members with similar complaints typically present with conjunctivitis from an infectious cause.
- A history of a recent upper respiratory infection (URI) typically is associated with a viral cause.
Specific helpful clues in differentiating the causes of conjunctivitis are listed below.
- Bacterial conjunctivitis
- Preauricular adenopathy sometimes occurs; chemosis (thickened, boggy conjunctiva) is common.
- Discharge is copious; discharge quality is thick and purulent. Conjunctival injection is moderate or marked.
- Viral conjunctivitis
- Preauricular adenopathy is common in herpes.
- Discharge amount is moderate, stringy, or sparse; discharge quality is thin and seropurulent. Conjunctival injection is moderate or marked.
- Chlamydial conjunctivitis tends to be chronic with exacerbation and remission.
- Preauricular adenopathy is occasional; chemosis is rare.
- Discharge amount is minimal; discharge quality is seropurulent. Conjunctival injection is moderate.
- Allergic conjunctivitis occurs with pruritus as the hallmark symptom.
- Preauricular adenopathy is absent; chemosis is common.
- Discharge amount is moderate, stringy, or sparse; discharge quality is clear. Conjunctival injection is moderate.
- Marginal ulcers (small white ulcers that appear on the cornea at the limbus) may indicate an allergic reaction to staphylococcal antigen.
- This is a toxin-related complication of staphylococcal species that frequently cause blepharitis.
- Pain, photophobia, and a foreign-body sensation are common. The ulcers are sterile and respond to topical steroids.
- Bilateral disease typically is infectious or allergic.
- Unilateral disease suggests toxic, chemical, mechanical, or lacrimal origin.
Acute conjunctivitis occurs with almost equal frequency between bacterial and viral causes. Some have noted that viral conjunctivitis occurs more frequently in the summer, and bacterial conjunctivitis occurs more often in the winter and spring.
Treatment with antimicrobials and symptomatic therapy is recommended for all patients initially presenting to the office with simple conjunctivitis.
Numerous topical antimicrobial agents may be used, including topical sulfacetamide, erythromycin, gentamicin, ciprofloxacin, or ofloxacin.
Instill drops every 2 hours. An ointment can be used at night or every 4-6 hours throughout the day.
If a question on the therapy for classic conjunctivitis offers options of:
- Saline
- Good hand washing
- Steroid opthalmologic drops
- Gentamycin drops
Choose antibiotic therapy (#4) Remember the BEST answer is wanted.