Conjunctivitis

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More about Conjunctivitis: Causes and symptoms Diagnosis Treatment Alternative treatment Prognosis Prevention Resources

Definition

Conjuctivitis is an inflammation or redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultra-violet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye problem because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can also affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pink eye and red eye.

— Lisa Papp, RN

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Dictionary: con·junc·ti·vi·tis  (kən-jŭngk'tə-vī'tĭs)

Inflammation of the conjunctiva, characterized by redness and often accompanied by a discharge.

Inflammation of the conjunctiva, the thin protective membrane lining the eyelids and covering the front surface of the eye. Conjunctivitis may be due to a viral or bacterial infection, or chemical irritation. Bacterial infections can cause pus to form. Such purulent infections can be exacerbated by exercise. Chlorine in swimming pool water commonly acts as a chemical irritant resulting in conjunctivitis, similar to that caused by bacterial infections. Wearing goggles offers protection against this condition.

An inflammation of the conjunctiva, caused by bacterial or viral infection, allergy, or environmental factors. Also called pinkeye.

Definition

Conjuctivitis is an inflammation (redness) of the lining of the white part of the eye and the underside of the eyelid (conjunctiva). It can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is a common eye problem because the conjunctivae are continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes. If it is caused by infection, it can be easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pinkeye and redeye.

Causes & Symptoms

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms may include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and a watery, yellow, or greenish discharge. The symptoms may last anywhere from several days to weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy sensation in the eye. These symptoms may also be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis may occur in adults or children. It is caused by such organisms as Staphylococcus, Streptococcus pneumoniae, and Haemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctivae can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with chlamydia or with the bacteria that cause gonorrhea. There may be large amounts of pus-like discharge. Symptoms may include hypersensitivity to light (photophobia), a watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by such environmental hazards as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.

Other less common causes of conjunctivitis include looking at the sun, sun lamps, plant lamps, or the electrical arcs used during welding, as well as defective tear ducts.

Diagnosis

Accurate diagnosis of conjunctivitis centers on taking the patient's history to learn when symptoms began, how long the condition has been going on, the symptoms experienced, and other predisposing factors. Diagnostic tests may include an eye examination, culture, or laboratory test. The discharge may be cultured and Gramstained to determine the organism responsible for causing the condition. Cultures and smears are relatively painless.

Treatment

Conjunctivitis caused by gonococcal or chlamydial infection usually requires prescription antibiotics. Internal immune enhancement with dietary supplements can aid in the resolution of allergic and viral conjunctivitis. Removal of the allergic agent is an essential step in treating allergic conjunctivitis. As with any of the recommended treatments, however, if no improvement is seen within 48–72 hours, a physician should be consulted.

Nutritional Therapy

The following dietary changes may be helpful in managing conjunctivitis:

• Taking 25,000 IU (international units) of beta-carotene twice daily for 7 days.
• Taking 500–1000 mg of vitamin C three times daily for 7 days.
• Taking 25 mg of zinc with meals three times daily for 7 days.

Homeopathy

There are a number of homeopathic remedies designed to treat acute conjunctivitis. These include Argentum nitricum (silver nitrate), pulsatilla (windflower), belladonna, Arsenicum album (arsenic trioxide), sulphur (elemental sulphur) and eyebright (Euphrasia officinalis). Eye drops prepared with homeopathic remedies can be a good substitute for pharmaceutical eye drops.

Herbal Therapy

Herbal eyewashes made with eyebright (1 tsp dried herb steeped in 1 cup of boiling water for 10 minutes, then strained and used at once) or chamomile (Matricaria recutita; 2–3 tsp in 1 pint of boiling water) may be helpful. Eyewashes should be strained and cooled before use. They should be discarded promptly after use, as old infusions may become unsterile.

Other simple home remedies may help relieve the discomfort associated with conjunctivitis. A boric acid eyewash (1 tsp boric acid in 1 cup of water) can be used to clean and soothe the eyes. A warm compress applied to the eyes for 5–10 minutes three times a day can help relieve the discomfort of bacterial and viral conjunctivitis. A clean washcloth soaked in warm water can be used as a warm compress. The patient should close both eyes and apply the compress to the affected eye. A cool compress or cool, damp tea bags (of black tea or chamomile tea) placed on the eyes can ease the discomfort of conjunctivitis.

Allopathic Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the eye(s) and applying topical antimicrobial ointments to prevent secondary bacterial infections.

Viral conjunctivitis may cause blindness and should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for 7–14 days. Patients should contact their doctors if the eyes fail to improve after 72 hours. Antibiotic eye drops are instilled (put in drop by drop) into the eye by having the patient tilt the head back and pulling down the lower eye lid. The patient is asked to look upward while the medication is instilled into the conjunctival sac. It is important to avoid touching the dropper to the skin, in order to prevent the eye discharge from contaminating the antibiotic solution. After the drops have been instilled, the patient should gently close the eyes for 1 minute in order not to squeeze out any of the medication.

For cases of conjunctivitis caused by a gonococcus (the bacteria that causes gonorrhea), a physician may prescribe an injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for 2–3 weeks. For chlamy-dial infections, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied 1–2 times daily. To apply an antibiotic ointment, the eye should be gently wiped with a sterile cotton ball moistened with sterile water to remove any discharge. Then, the lower eyelid can be pulled down and a thin ribbon of ointment applied in the lower conjunctival sac. If possible, single-dose dispensers of ointment should be used as a protection against contamination of the medication. The eyelids can be closed and massaged gently to distribute the ointment. Patients may find that their vision is blurry for a few minutes after the ointment is applied, but this is a normal side effect. In addition to topical antibiotics, oral erythromycin or tetracycline therapy may be indicated for 3–4 weeks. Sexual partners should also be treated.

Children with conjunctivitis should typically receive topical antibiotics, according to clinical evidence published in 2002. But the evidence re-emphasized that adults who have non-gonococcal conjunctivitis usually do not need antibiotic treatment, because antibiotic resistance is a growing problem.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops 4–6 times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes. In 2002, a new study showed that loteprednol and azelastine are two potential treatments for allergic conjunctivitis. Some doctors have prescribed ophthalimic steroids, but they can cause complications in patients. These potential new treatments offer alternatives to steroids for patients with allergic conjunctivitis.

Expected Results

If conjunctivitis is treated properly, its prognosis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. Allergic conjunctivitis, however, will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, usually resolves in 10–14 days. If there is no relief of symptoms in 48–72 hours; or if there is moderate to severe eye pain or changes in vision; or if the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to such other parts of the eye as the cornea.

Prevention

Conjunctivitis can be prevented in many cases; in others, the course of the disease can be shortened by following some simple practices:

• Washing hands frequently using antiseptic soap; using single-use towels during the disease to prevent spreading the infection.
• Avoiding chemical irritants and known allergens.
• In areas where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes.
• Using a clean tissue to remove discharge from eyes, and washing hands to prevent the spread of infection.
• If medication is prescribed, finishing the course of antibiotics as directed to make sure that the infection is cleared up and does not recur.
• Avoiding wearing eye makeup or contact lenses during the infection. Never share eye makeup with others.

Resources

Books

Jonas, Wayne B. and Jennifer Jacobs. Healing with Homeopathy: The Doctor's Guide. New York: Warner Books, 1996.

Newell, Frank, ed. Ophthalmology: Principles and Concepts. 8th ed. St. Louis: Mosby-Year Books Inc., 1996.

Schwab, Ivan R., and Chandler R. Dawson. "Conjunctiva." In General Ophthalmology, 14th ed. Daniel G. Vaughan, Taylor Asbury, and Paul Riordan-Eva, eds. Norwalk, CT: Appleton and Lange, 1995.

Uphold, Constance R. and Mary Virginia Graham. "Problems of the Eyes." In Clinical Guidelines in Adult Health. Gainesville, FL: Barmarrae Books, 1994.

Zand, Janet, Allan N. Spreen, and James B. LaValle. Smart Medicine for Healthy Living. Garden City Park, NY: Avery Publishing Group, 1999.

Periodicals

Guttman, Cheryl. "Lotepredol, Azelastine Provide Potent Arsenal for Acute, Chronic Allergic Conjunctivitis: Longer–term use Proving Safe, Effective for Patients with both Seasonal and Perennial Allergies."Ophthalmology Times (April 15, 2002): 30.

Kane, Kevin Y., et al. "When Should Acute Nonveneral Conjunctivitis be Treated with Topical Antibiotics? (Clinical Inquiries: from the Family Practice Inquiries Network)." Journal of Family Practice (April 2002).

[Article by: Mai Tran; Teresa G. Odle]

Definition

Conjuctivitis is an inflammation resulting in redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye disease because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending on how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a school or daycare setting. Other names for conjunctivitis include pink eye and red eye.

Demographics

Conjunctivitis is the most common eye infection of childhood. It occurs so frequently that records are not kept, so exact demographic information has not been amassed.

Causes and Symptoms

Conjunctivitis may be caused by a viral infection, such as a cold; acute respiratory infection; or other disease such as measles, herpes simplex, or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy, foreign-body-sensation in the eye. These symptoms may be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of pus-like discharge, and symptoms may include intolerance to light (photophobia), watery mucus discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucus discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by various eye solutions used and the foreign proteins contained in them.

Other less common causes of conjunctivitis include exposureto sun lamps or the electrical arcs used during welding and problems with inadequate drainage of the tear ducts.

Diagnosis

An accurate diagnosis of conjunctivitis centers on taking a patient's history to learn what symptoms are being experienced, when symptoms began, and other predisposing factors, such as upper respiratory complaints, allergies, sexually transmitted diseases, herpes simplex infections, and exposure to persons with pink eye. It may be helpful to learn whether an aspect of an individual's occupation may be the cause, for example, welding. Diagnostic tests are usually not indicated unless initial treatment fails or an infection with gonorrhea or chlamydia is suspected. In such cases, the discharge may be cultured and tested to determine the organism responsible for causing the condition.

Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the affected area and using topical antibiotic ointments to prevent secondary bacterial infections.

Viral conjunctivitis caused by herpes simplex should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for seven to 14 days. If, after 72 hours, the condition does not improve, a physician or primary care provider should be notified, because the bacteria involved may be resistant to the antibiotic used or the cause may not be bacterial.

For cases of conjunctivitis caused by a gonococcal organism, a physician may prescribe an intramuscular injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for two to three weeks. Sexual partners should also be treated.

With accompanying chlamydia infection, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied one to two times daily. In addition, oral erythromycin or tetracycline therapy may be indicated for three to four weeks. Again, sexual partners should also be treated.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops four to six times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes.

Prognosis

If treated properly, the prognosis for conjunctivitis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. However, allergic conjunctivitis will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, is usually resolved in ten to 14 days. If there is no relief of symptoms in 48 to 72 hours, or there is moderate to severe eye pain, changes in vision, or the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to other parts of the eye, such as the cornea.

Prevention

Conjunctivitis can, in many cases, be prevented, or at least the course of the disease can be shortened by following these simple practices:

• frequently washing hands with antiseptic soap and using single-use towels while the disease continues
• avoiding chemical irritants and known allergens
• in an area where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes
• using a clean tissue to remove discharge from eyes and washing hands to prevent the spread of infection
• if medication is prescribed, finishing the course of antibiotics, as directed, to make sure that the infection is cleared up and does not recur
• avoiding close contact, such as vigorous physical activities, with other persons until symptoms resolve

Resources

Books

"Disorder of the Conjunctiva." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Weiss, Avery H. "Conjunctivitis Beyond the Neonatal Period." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Web Sites

Silverman, Michael A., et al. "Conjunctivitis." eMedicine, October 12, 2004. Available online at www.emedicine.com/emerg/topic110.htm (accessed December 25, 2004).

[Article by: Lisa Papp, RN Rosalyn Carson-DeWitt, MD]

For more information on conjunctivitis, visit Britannica.com.

Inflammation of the conjunctiva (the thin, protective mucous membrane lining the eyelids and covering the anterior surface of the eye). Conjunctivitis may be due to a viral or bacterial infection, or chemical irritation. Bacterial infections can cause pus formation. Such purulent infections can be exacerbated by exercise. Chlorine in the water of swimming pools commonly acts as a chemical irritant causing conjunctivitis similar to purulent infections. Conjunctivitis in skiers and ice skaters can also be caused by cold injury to the cornea. Wearing goggles offers protection against these conditions.

Inflammation of the conjunctiva, the transparent mucous membrane that lines the inner surface of the eyelid and covers the front part of the eyeball. Often called pinkeye.

Inflammation of the conjunctiva. Extension of the inflammation to the cornea is common, hence keratoconjunctivitis. Individual cases may be due to trauma or to grass seed or other foreign body intrusion. The most serious conjunctivitides are the infectious ones, including those in which conjunctivitis is only an incidental lesion to more serious problems, e.g. rinderpest, malignant catarrhal fever, canine distemper, infectious bovine rhinotracheitis. The common specific conjunctivitides are Moraxella bovis infection in cattle, Rickettsia conjunctivae in sheep, goats and pigs, but there is no such infection in horses. In cats, feline herpesvirus and Chlamydophila felis cause a conjunctivitis. Parasitic conjunctivitis may be caused by Habronema spp. in horses and Thelazia spp. in all species. Classical signs of the disease are ocular discharge, serous at first, purulent later, and blepharospasm. Both eyes may be affected. Under-running of the conjunctiva and permanent opacity, even rupture of the eyeball, may follow.

• equine seasonal c. — irritation caused by flies (Musca domestica) or release of Habronema larvae; called also summer conjunctivitis.
• fetal c. — present in many cases of intrauterine infection and the causative organism can be cultured from the site.
• follicular c. — proliferation of lymphoid tissue on the bulbar surface of the third eyelid, often extending to the adjacent bulbar and palpebral conjunctiva in response to any chronic inflammation or stimulation such as dust, entropion, ectropion, distichiasis or bacterial infection.
• ligneous c. — a chronic, membranous conjunctivitis involving the lids and third eyelid with deposition of amorphous eosinophilic hyaline material in the subconjunctival tissues. Young female Doberman pinschers may be predisposed.
• c. neonatorum — neonatal kittens infected by feline herpesvirus may have severe ocular involvement, even before their eyelids become unsealed. Ulcerative keratitis and panophthalmitis are common sequelae.
• primary c. — caused by infectious agents, parasites or toxic agents affecting the conjunctiva in the first instance.
• secondary c. — associated with foreign bodies or diseases of the cornea, lacrimal system, eyelids, orbit, or body as a whole.

"Pink Eye" redirects here. For the South Park episode, see Pinkeye (South Park episode).

Conjunctivitis
Classification & external resources

An eye with viral conjunctivitis
ICD-10	H10.
ICD-9	372.0-372.3
DiseasesDB	3067
MedlinePlus	001010
eMedicine	emerg/110

Conjunctivitis (commonly called "pinkeye" or bloodshot eyes in the USA and "Madras Eye" in India) is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually bacterial or viral).

Blepharoconjunctivitis is the combination of conjunctivitis with blepharitis (inflammation of the eyelids).

Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation).

Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing.

Diagnosis

Symptoms

Eyes with conjunctivitis.

Redness, irritation and watering of the eyes are symptoms common to all forms of conjunctivitis. Itch and the closing of the throat is variable.

Acute allergic conjunctivitis is typically itchy. Sometimes distressingly so, and the patient often complains of some lid swelling. Chronic allergy often causes just itch or irritation, and often much frustration because the absence of redness or discharge can lead to accusations of hypochondria.

Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the fellow eye.

Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge (gowl, goop, sleep, or other regional names) that may cause the lids to stick together (matting), especially after sleeping. Another symptom that could be caused by Bacterial Conjunctivitis is severe crusting of the infected eye and the surrounding skin. However discharge is not essential to the diagnosis, contrary to popular belief. Many other bacteria (e.g., Chlamydia, Moraxella) can cause a non-exudative but very persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localised enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye.

Irritant or toxic conjunctivitis is irritable or painful when the infected eye is pointed far down or far up. Discharge and itch are usually absent. This is the only group in which severe pain may occur.

Signs

One eye with conjunctivitis.

Infection (redness) of the conjunctiva on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.

Allergic conjunctivitis shows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness. Viral conjunctivitis, commonly known as "pink eye", shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis.

Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma.

Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals—above all with caustic alkalis such as sodium hydroxide—there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis.

Differential diagnosis

Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicrosopy, laboratory tests are often necessary if proof of aetiology is needed.

A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious.

A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.

Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.

Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.

Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula.

Investigations

These are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities.

Swabs for bacterial culture are necessary if the history & signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate that many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so negative results are common. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.

Treatment and management

Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria (chloramphenicol or fusidic acid used in UK). However evidence suggests that this does not affect symptom severity and gains only modest reduction in duration from an average of 4.8 days (untreated controls) to 3.3 days for those given immediate antibiotics. Deferring antibiotics yields almost the same duration as those immediately starting treatment with 3.9 days duration, but with half the two-week clinic reattendance rate.^[1]

Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with cool compresses and artificial tears. For the worst cases, topical corticosteroid drops may be prescribed to reduce the discomfort from inflammation. However prolonged usage of corticosteroid drops increases the risk of side effects. Antibiotic drops may also be used for treatment of complementary infections. Patients are often advised to avoid touching their eyes or sharing towels and washcloths. Viral conjunctivitis usually resolves within 3 weeks. However in worst cases it may take over a month.

Conjunctivitis due to burns, toxic and chemical require careful wash-out with saline, especially beneath the lids, and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, and intraocular damage. Fortunately, such injuries are uncommon.

Footnotes

1. ^ Hazel A Everitt, Paul S Little, Peter W F Smith (July 16 2006). "A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice". BMJ. doi::10.1136/bmj.38891.551088.7C. 

External links

• Facts About the Cornea and Corneal Disease The National Eye Institute (NEI).
• All About Conjunctivitis

Pathology of the eye (primarily H00-H59, 360-379)
Eyelid, lacrimal system and orbit	Stye - Chalazion - Blepharitis - Entropion - Ectropion - Lagophthalmos - Blepharochalasis - Ptosis - Xanthelasma - Trichiasis - Dacryoadenitis - Epiphora - Exophthalmos - Enophthalmos
Conjunctiva	Conjunctivitis - Pterygium - Pinguecula - Subconjunctival hemorrhage
Sclera and cornea	Scleritis - Keratitis - Corneal ulcer - Snow blindness - Thygeson's superficial punctate keratopathy - Fuchs' dystrophy - Keratoconus - Keratoconjunctivitis sicca - Arc eye - Keratoconjunctivitis - Corneal neovascularization - Kayser-Fleischer ring - Arcus senilis - Band keratopathy
Iris and ciliary body	Iritis - Uveitis - Iridocyclitis - Hyphema - Persistent pupillary membrane
Lens	Cataract - Aphakia
Choroid and retina	Chorioretinitis - Choroideremia - Retinal detachment - Retinoschisis - Retinopathy (Hypertensive retinopathy, Diabetic retinopathy, Retinopathy of prematurity) - Macular degeneration - Retinitis pigmentosa - Retinal haemorrhage - Central serous retinopathy - Macular edema - Epiretinal membrane - Macular pucker
Optic nerve and visual pathways	Optic neuritis - Papilledema - Optic atrophy - Leber's hereditary optic neuropathy
Ocular muscles, binocular movement, accommodation and refraction	Paralytic strabismus: Ophthalmoparesis - Progressive external ophthalmoplegia - Palsy (III, IV, VI) - Kearns-Sayre syndrome Other strabismus: Esotropia/Exotropia - Hypertropia - Heterophoria (Esophoria, Exophoria) - Brown's syndrome - Duane syndrome Other binocular: Conjugate gaze palsy - Convergence insufficiency - Internuclear ophthalmoplegia - One and a half syndrome Refractive error: Hyperopia/Myopia - Astigmatism - Anisometropia/Aniseikonia - Presbyopia
Visual disturbances and blindness	Amblyopia - Leber's congenital amaurosis - Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) - Diplopia - Scotoma - Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) - Color blindness (Achromatopsia) - Nyctalopia - Blindness/Low vision
Pupil	Anisocoria - Argyll Robertson pupil - Marcus Gunn pupil/Marcus Gunn phenomenon - Adie syndrome
Infectious diseases	Trachoma - Onchocerciasis
Other	Nystagmus - Miosis - Mydriasis - Glaucoma - Floater - Leber's hereditary optic neuropathy - Red eye - Keratomycosis - Xerophthalmia - Aniridia

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Dansk (Danish)
n. - bindehindebetændelse i øjet

Nederlands (Dutch)
bindvliesontsteking

Français (French)
n. - conjonctivite

Deutsch (German)
n. - Bindehautentzündung

Ελληνική (Greek)
n. - (παθολ.) επιπεφυκίτιδα

Italiano (Italian)
congiuntivite

Português (Portuguese)
n. - conjuntivite (f) (Med.)

Русский (Russian)
конъюнктивит

Español (Spanish)
n. - conjuntivitis

Svenska (Swedish)
n. - konjunktivit, bindhinneinflammation

中文（简体） (Chinese (Simplified))
结膜炎

中文（繁體） (Chinese (Traditional))
n. - 結膜炎

한국어 (Korean)
n. - 결막염

日本語 (Japanese)
n. - 結膜炎

العربيه (Arabic)
‏(الاسم) التهاب باطن الجفن‏

עברית (Hebrew)
n. - ‮דלקת הלחמית‬

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