Conjunctivitis is a clinical diagnosis of

exclusion. The diagnosis can be made in a

patient with a red eye and discharge only if
the vision is normal and there is no evidence
of keratitis, iritis, or angle closure glaucoma

The redness or injection in conjunctivitis should be diffuse, involving the

bulbar (globe) conjunctiva for 360 as well as the palpebral or tarsal
conjunctiva (the mucus membrane on the inner surface of the lids).
Another diagnosis such as foreign body, pterygium, or episcleritis should
be considered if the conjunctival injection is localized rather than diffuse.
(See "Pterygium" and "Episcleritis" .)

The serious conditions that cause a red eye, keratitis, iritis, and angle
closure, will cause 360 involvement of the bulbar conjunctiva, often in a
ciliary flush pattern, but will spare the tarsal conjunctiva. (See 'Red flags'
below.)

Red flags A detailed description of how to take a history and examine a patient
with a red eye is discussed elsewhere. (See "Evaluation of the red eye" .) Warning
signs of a more serious problem that should prompt evaluation by an ophthalmologist
include:

Reduction of visual acuity

Ciliary flush: A pattern of injection in which the redness is most pronounced in

a ring at the limbus (the limbus is the transition zone between the cornea and
the sclera)

Photophobia

Severe foreign body sensation that prevents the patient from keeping the eye
open

Corneal opacity

Fixed pupil

Severe headache with nausea

THERAPY