• Conjunctivitis is the inflammation of the conjunctiva,

which is the clear membrane covering the sclera and

interior lining of eyelids.
• Only occurs in the eye

• The inflammation of the conjunctiva cause the eye’s

blood vessels to dilate, resulting in the reddish
appearance
CLASSIFICATION
• Infectious
• Viral
• Bacterial
• Hyper acute
• Acute
• Chronic
• Non-infectious
• Allergic
• Toxins or chemicals
• Trauma
EPIDEMIOLOGY
Prevalence of the etiologies of acute conjunctivitis

Prevalence (%) Adults Pediatrics

Bacterial 40 80

viral 60 13

Allergic See below 2

No diagnosis 24 (including allergic) 5

VIRAL CONJUNCTIVITIS
• Often associated with common cold, caused by adenovirus

• Occurs in community epidemics (schools, workplaces, physicians’

offices)

• Usual modes of transmission:

• contaminated fingers
• medical instruments
• swimming pool water
VIRAL CONJUNCTIVITIS
Presentation
• unilateral or bilateral
• Acutely red eye
• Watery or mucoserous discharge
• Chemosis (swelling of conjunctiva)
• Tender preauricular node
• Burning/sanding/gritty feeling in eye(s)
• Rarely photophobia
ACUTE BACTERIAL CONJUNCTIVITIS
Common etiologies of Acute bacterial conjunctivitis

Neonates Chlamydia trachomatis, Neisseria

gonorrhoeae

Children Haemophilus influenzae (80%),

Streptococcus pneumoniae (20%),
and Moraxella catarrhalis.

Adults Staphylococcus aureus

ACUTE BACTERIAL CONJUNCTIVITIS
• Presentation
• Unilateral or bilateral
• Red eye
• Mucopurulent or purulent discharge continuously throughout the
day
• Burning/sanding/gritty feeling in the eyes
• Irritation
• Mild chemosis
HYPERACUTE BACTERIAL CONJUNCTIVITIS
Etiology
• Neisseria species, most commonly N. gonorrhoeae

Presentation
• Purulent discharge with rapidly progressive symptoms of marked
conjunctival infection
• Irritation
• Tenderness to palpation
• Chemosis
• Lid swelling
• Tender preauricular adenopathy
• Ophthalmia neonatorum (Neonatal conjunctivitis): gonococcal
ocular infection with bilateral discharge 3-5d after birth from
vaginal transmission

• Sexually active teens: transmitted from genitalia to hands to eyes,

commonly see concurrent urethritis

• Sight-threatening
CHRONIC BACTERIAL CONJUNCTIVITIS
Etiology
• Staphylococcus species
• More common in adults and patients with acne rosacea or facial
seborrhea
• Presentation varies:
• Redness
• Itching
• Burning
• Foreign-body sensation
• Flaky debris
• Blepharitis (eyelid inflammation; common)
• Eyelash loss
ALLERGIC CONJUNCTIVITIS
• Most commonly seasonal allergic rhinoconjunctivitis, also called
hay fever rhinoconjunctivitis
• IgE mediated hypersensitivity reaction precipitated by small
airborne allergens→ local mast cell degranulation → release of
chemical mediators (histamine, eosinophil chemotactic factors, etc.)
Presentation
• bilateral, pruritus, redness, watery discharge, rhinorrhea/congestion

• Patients often have h/o atopy, seasonal allergy or specific allergy

TREATMENT

• Viral, allergic, and nonspecific conjunctivitis are self-limited

• Bacterial conjunctivitis is also likely to be self-limited but

antibiotics treatment

• Shortens the course

• Reduces person-to-person spread
• Lowers the risk of sight-threatening complications
VIRAL CONJUNCTIVITIS
• Topical antibiotics not necessary because secondary bacterial
infection is uncommon
• Reassurance that the symptoms may get worse for 3-5d before
getting better and persist for 2-3 weeks
• Some relief from cold compresses
• Do not use topical corticosteroids due to risk of sight-threatening
complications (scarring, corneal melting, perforation), especially if
etiology is herpes simplex virus or bacterial keratitis
ACUTE BACTERIAL CONJUNCTIVITIS
Topical broad-spectrum antibiotics
• Erythromycin ointment
• Bacitracin-polymyxin B ointment
• Trimethropim-polymyxin B
• Sulfa drops

• Most H. flu and S. pneumoniae resistant to macrolides

• Sulfa drops: less effective and rare side effect of Stevens-Johnson

syndrome
• Rx: ointment inside lower lid or 1-2 drops QID for 5-7 days
(response seen typically within 1-2d)

• Inclusion Conjunctivitis of the Newborn: treat with 2 week course of

erythromycin (50mg/kg/d po divided QID) or sulfisoxazole
(150mg/kg/d po divided QID)
HYPERACUTE BACTERIAL CONJUNCTIVITIS
• Immediate ophthalmic referral
• Systemic and topical antibiotics and saline irrigation
• Systemic antibiotic of choice due to penicillin-resistant N.
gonorrhoeae is single-dose Ceftriaxone (25-50mg/kg IV or IM, not
to exceed 125mg) or single-dose Cefotaxime (100mg/kg IV or IM)
in neonates
• If venereal disease present in teens, also treat with single- dose of
azithromycin (1g) because over 30% of these patients will have
concurrent chlamydial disease
ALLERGIC CONJUNCTIVITIS
• Self-limited
• Allergen avoidance
• cold compresses
• topical antihistamines/vasoconstrictors (do not use for greater than 2
weeks), artificial tears, topical NSAIDS (low efficacy)
• Prophylaxis: oral antihistamines, mast cell stabilizers