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Conjunctivitis

Jonathan A. Barnett

Background and Presentation

  • Allergic, viral, or bacterial cause

  • All forms present with red and irritated conjunctiva

  • In practice it can be difficult to distinguish between the types of conjunctivitis. However, these are rough guidelines:

    • Allergic: hx of allergies/atopy, bilateral, chemosis, watery/mucoid discharge, itchiness predominant symptom

    • Viral: hx of recent URI or exposure, unilateral first then bilateral, itchy/burning, subconjunctival hemorrhages or petechiae, watery/mucoid discharge, tender preauricular lymph nodes

    • Bacterial: itching less prominent, burning/aching/stabbing discomfort predominates, unilateral first then bilateral, mucoid/purulent discharge (and more copious)

  • Blurry vision is common, but loss of vision should not occur if disease limited to conjunctiva.

Management:

  • Allergic: eliminate allergen, artificial tears, antihistamine/mast-cell stabilizer drops (olopatadine, ketotifen), oral antihistamine (diphenhydramine, loratadine)

  • Viral: 4-8x/day artificial tears, cold compresses, isolation precautions.

  • Bacterial: culture/swab the ocular discharge, isolation precautions, moxifloxacin drops (Vigamox) QID or trimethoprim/polymyxin B drops/ointment for 5-7 days

  • Consult ophthalmology if concern for worsening