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  • Print publication year: 2015
  • Online publication date: April 2015

11 - Conjunctivitis

from Part III - Clinical syndromes: eye

Summary

Conjunctivitis is a nonspecific term used to describe inflammation of the ocular surface and conjunctiva from either infectious or noninfectious causes. Infectious conjunctivitis is most commonly due to exogenous inoculation of the mucous membranes lining the surface of the eye and eyelid, resulting in an activation of a local inflammatory response. The vast majority of cases are acute but it may also present as chronic or recurrent. Although most cases of acute infectious conjunctivitis are self-limited and result in few long-term sequelae, appropriate evaluation and therapy are indicated with specific presentations.

Clinical features

The hallmark of conjunctivitis is injection or hyperemia of the conjunctival vessels, resulting in a red eye as well as tearing and/or mucopurulent discharge. Conjunctivitis may also result in complaints of irritation, foreign-body sensation, mattering or crusting of the eyelids, and mild visual blurring primarily due to alterations of the tear layer. The local inflammatory response may manifest as conjunctival lymphoid follicles or vascular papillae, eyelid edema, and/or preauricular adenopathy. Complaints of severe eye pain, photophobia, significant visual loss, or referred pain should alert the examiner to the possibility of other, more ominous, etiologies. Similarly, loss of normal corneal clarity, either diffuse or focal, proptosis, pupillary abnormalities, conjunctival scarring, or restriction of eye movement are criteria for a detailed ophthalmic evaluation (Table 11.1).

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Suggested reading
American Academy of Ophthalmology. Conjunctivitis, Preferred Practice Pattern. San Francisco, CA: American Academy of Ophthalmology; 2003.
Buznach, N, Dagan, R, Greenberg, D.Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era. Pediatr Infect Dis J. 2005;24:823–828.
Cortina, MS, Tu, EY.AAO Focal Points: Antibiotic Use in Corneal and External Eye Infections. San Francisco, CA: American Academy of Ophthalmology; 2011.
Mah, FS. New antibiotics for bacterial infections. Ophthalmol Clin North Am. 2003;16:11–27.
Rubenstein, JB. Disorders of the conjunctiva and limbus. In: Yanoff, M, ed. Ophthalmology. Philadelphia, PA: Mosby; 1999:5.1.2–5.1.11.
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Sheikh, A, Hurwitz, B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2006;(2):CD001211.
Stern, GA. AAO Focal Points: Chronic Conjunctivitis, Part 1. San Francisco, CA: American Academy of Ophthalmology, 2012.
Stern, GA. AAO Focal Points: Chronic Conjunctivitis, Part 2. San Francisco, CA: American Academy of Ophthalmology, 2012.
Tarabishy, AB, Hall, GS, Procop, GW, Jeng, BH. Bacterial culture isolates from hospitalized pediatric patients with conjunctivitis. Am J Ophthalmol. 2006;142:678–680.