Conjunctivitis differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Conjunctivitis}} | {{Conjunctivitis}} | ||
{{CMG}} {{AE}} {{SaraM}} | {{CMG}}; {{AE}} {{SaraM}} | ||
==Overview== | ==Overview== | ||
Conjunctivitis must be differentiated from [[blepharitis]], [[keratitis]], and [[scleritis]].<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425 }} </ref><ref name=Bacterial_Conjunctivitis > American Academy of ophthalmology (2016) http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016 </ref> Conjunctivitis symptoms and signs are relatively non-specific. Even after eye examination, laboratory tests are often necessary to determine the underlying pathophysiology with certainty. | |||
http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016 </ref> | |||
==Differentiating Conjunctivitis from Other Diseases== | ==Differentiating Conjunctivitis from Other Diseases== | ||
===Bacterial Conjunctivitis=== | ===Bacterial Conjunctivitis=== | ||
A [[ | A [[mucopurulent discharge]] strongly suggests [[bacterial]] cause, unless there is known exposure to [[toxins]]. Infection with ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]'' should be suspected if the discharge is particularly thick and copious. Bacterial conjunctivitis must be differentiated from:<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425 }} </ref><ref name=Bacterial_Conjunctivitis > American Academy of ophthalmology (2016) | ||
http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016 </ref> | http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016 </ref> | ||
* | * Viral conjunctivitis | ||
*[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] | *[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] | ||
*[[Glaucoma]] | *[[Glaucoma]] | ||
| Line 20: | Line 19: | ||
*[[Episcleritis]] | *[[Episcleritis]] | ||
*[[Scleritis]] | *[[Scleritis]] | ||
*[[Neisseria meningitis]] (it can lead to fatal [[meningeal]] or [[systemic infection]] in the patient with hyperacute conjunctivitis due to ''[[Neisseria gonorrhoeae]]'') | *[[Neisseria meningitis]] (it can lead to fatal [[meningeal infection|meningeal]] or [[systemic infection]] in the patient with hyperacute conjunctivitis due to ''[[Neisseria gonorrhoeae]]'') | ||
===Viral Conjunctivitis=== | ===Viral Conjunctivitis=== | ||
A diffuse, highly [[contagious]], characterized by watery discharge, less injected conjunctivitis (looking pink rather than red) suggests a [[viral]] cause. Viral | A diffuse, highly [[contagious]], characterized by watery discharge, less injected conjunctivitis (looking pink rather than red) suggests a [[viral]] cause. Viral conjunctivitis must be differentiated from:<ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792 }} </ref> | ||
* | *Bacterial conjunctivitis | ||
*Keratoconjunctivitis | *Keratoconjunctivitis | ||
*Nasolacrimal duct obstruction | *Nasolacrimal duct obstruction | ||
| Line 31: | Line 30: | ||
*[[Pharyngoconjunctival fever]] | *[[Pharyngoconjunctival fever]] | ||
===Neonatal conjunctivitis=== | ===Neonatal conjunctivitis=== | ||
Neonatal conjunctivitis must be differentiated from:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121 }} </ref> | Neonatal conjunctivitis must be differentiated from:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121 }} </ref><ref name=Conjun-One>Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.</ref> | ||
*Dacrocysitis | *Dacrocysitis | ||
*Congenital glaucoma | *Congenital glaucoma | ||
| Line 37: | Line 36: | ||
*Preseptal/Orbital [[cellulitis]] | *Preseptal/Orbital [[cellulitis]] | ||
*[[Keratitis]] | *[[Keratitis]] | ||
===Allergic conjunctivitis=== | ===Allergic conjunctivitis=== | ||
[[Allergic conjunctivitis]] has a protracted course, with the severity of [[symptoms]] waxing and waning throughout the allergy season. | [[Allergic conjunctivitis]] has a protracted course, with the severity of [[symptoms]] waxing and waning throughout the allergy season. It is characterized by itchy eyes, [[tearing]], bilateral [[eye redness]], and watery discharge. | ||
Allergic conjunctivitis must be differentiated from:<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref> | Allergic conjunctivitis must be differentiated from:<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref> | ||
*Viral conjunctivitis | *Viral conjunctivitis | ||
| Line 44: | Line 44: | ||
===Keratoconjunctivitis sicca=== | ===Keratoconjunctivitis sicca=== | ||
[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] must be differentiated from:<ref name="pmid27213053">{{cite journal| author=Zhang X, Zhao L, Deng S, Sun X, Wang N| title=Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. | journal=J Ophthalmol | year= 2016 | volume= 2016 | issue= | pages= 8201053 | pmid=27213053 | doi=10.1155/2016/8201053 | pmc=4861815 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27213053 }} </ref><ref name="pmid27179980">{{cite journal| author=Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E et al.| title=Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease. | journal=Ocul Surf | year= 2016 | volume= | issue= | pages= | pmid=27179980 | doi=10.1016/j.jtos.2016.04.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179980 }} </ref> | [[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] must be differentiated from:<ref name="pmid27213053">{{cite journal| author=Zhang X, Zhao L, Deng S, Sun X, Wang N| title=Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. | journal=J Ophthalmol | year= 2016 | volume= 2016 | issue= | pages= 8201053 | pmid=27213053 | doi=10.1155/2016/8201053 | pmc=4861815 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27213053 }} </ref><ref name="pmid27179980">{{cite journal| author=Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E et al.| title=Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease. | journal=Ocul Surf | year= 2016 | volume= | issue= | pages= | pmid=27179980 | doi=10.1016/j.jtos.2016.04.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179980 }} </ref> | ||
*Allergic conjunctivitis ( | *Allergic conjunctivitis (atopic and vernal keratoconjunctivitis) | ||
*[[Blepharitis]] | *[[Blepharitis]] | ||
*[[Bell's palsy]] | *[[Bell's palsy]] | ||
| Line 50: | Line 50: | ||
*[[Thyroid]] ophthalmopathy | *[[Thyroid]] ophthalmopathy | ||
===Superior limbic keratoconjunctivitis=== | ===Superior limbic keratoconjunctivitis=== | ||
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] is [[chronic]] condition with [[remission]] and [[exacerbations]], and it must be differentiated from: | [[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] is [[chronic]] condition with [[remission]] and [[exacerbations]], and it must be differentiated from:<ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237 }} </ref> | ||
<ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237 }} </ref> | |||
*Infective conjunctivitis | *Infective conjunctivitis | ||
*[[Allergic conjunctivitis]] | *[[Allergic conjunctivitis]] | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
] | |||
{{WH}} | |||
{{WS}} | |||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:Immunology]] | [[Category:Immunology]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Endocrinology]]] | [[Category:Endocrinology]] | ||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 21:07, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Conjunctivitis must be differentiated from blepharitis, keratitis, and scleritis.[1][2] Conjunctivitis symptoms and signs are relatively non-specific. Even after eye examination, laboratory tests are often necessary to determine the underlying pathophysiology with certainty.
Differentiating Conjunctivitis from Other Diseases
Bacterial Conjunctivitis
A mucopurulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae and Chlamydia trachomatis should be suspected if the discharge is particularly thick and copious. Bacterial conjunctivitis must be differentiated from:[1][2]
- Viral conjunctivitis
- Keratoconjunctivitis sicca (dry eye syndrome)
- Glaucoma
- Blepharitis
- Uveitis
- Iritis
- Keratitis
- Episcleritis
- Scleritis
- Neisseria meningitis (it can lead to fatal meningeal or systemic infection in the patient with hyperacute conjunctivitis due to Neisseria gonorrhoeae)
Viral Conjunctivitis
A diffuse, highly contagious, characterized by watery discharge, less injected conjunctivitis (looking pink rather than red) suggests a viral cause. Viral conjunctivitis must be differentiated from:[3]
- Bacterial conjunctivitis
- Keratoconjunctivitis
- Nasolacrimal duct obstruction
- Foreign body
- Keratitis
- Uveitis
- Pharyngoconjunctival fever
Neonatal conjunctivitis
Neonatal conjunctivitis must be differentiated from:[4][5]
- Dacrocysitis
- Congenital glaucoma
- Nasolacrimal duct obstruction
- Preseptal/Orbital cellulitis
- Keratitis
Allergic conjunctivitis
Allergic conjunctivitis has a protracted course, with the severity of symptoms waxing and waning throughout the allergy season. It is characterized by itchy eyes, tearing, bilateral eye redness, and watery discharge. Allergic conjunctivitis must be differentiated from:[6]
- Viral conjunctivitis
- Bacterial conjunctivitis
Keratoconjunctivitis sicca
Keratoconjunctivitis sicca (dry eye syndrome) must be differentiated from:[7][8]
- Allergic conjunctivitis (atopic and vernal keratoconjunctivitis)
- Blepharitis
- Bell's palsy
- Keratoconjunctivitis sicca (dry eye syndrome)
- Thyroid ophthalmopathy
Superior limbic keratoconjunctivitis
Superior limbic keratoconjunctivitis (SLK) is chronic condition with remission and exacerbations, and it must be differentiated from:[9]
- Infective conjunctivitis
- Allergic conjunctivitis
- Keratoconjunctivitis sicca (dry eye syndrome)
- Floppy eyelid syndrome
- Thyroid ophthalmopathy
- Ocular surface squamous neoplasia
- Sebaceous gland carcinoma
- Episcleritis
- Trachoma
References
- ↑ 1.0 1.1 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ 2.0 2.1 American Academy of ophthalmology (2016) http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016
- ↑ Rose P (2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother. 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792.
- ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.
- ↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). "Allergic conjunctivitis: a comprehensive review of the literature". Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
- ↑ Zhang X, Zhao L, Deng S, Sun X, Wang N (2016). "Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics". J Ophthalmol. 2016: 8201053. doi:10.1155/2016/8201053. PMC 4861815. PMID 27213053.
- ↑ Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E; et al. (2016). "Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease". Ocul Surf. doi:10.1016/j.jtos.2016.04.003. PMID 27179980.
- ↑ Watson S, Tullo AB, Carley F (2002). "Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens". Br J Ophthalmol. 86 (4): 485–6. PMC 1771108. PMID 11914237.