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==Overview==
==Overview==
Diseases with symptoms similar to conjunctivitis include [[Keratoconjunctivitis sicca]] and [[Trachoma]].
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.  


==Differentiating Conjunctivitis from other Diseases==
==Differentiating Conjunctivitis from Other Diseases==
Conjunctivitis symptoms and signs are relatively non-specific. Even after [[biomicrosopy]], laboratory tests are often necessary to determine the underlying pathophysiology with certainty.
===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:<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>
* Viral conjunctivitis
*[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]
*[[Glaucoma]]
*[[Blepharitis]]
*[[Uveitis]]
*[[Iritis]]
*[[Keratitis]]
*[[Episcleritis]]
*[[Scleritis]]
*[[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===
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
*Nasolacrimal duct obstruction
*[[Foreign body]]
*[[Keratitis]]
*[[Uveitis]]
*[[Pharyngoconjunctival fever]]
===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><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
*Congenital glaucoma
*Nasolacrimal duct obstruction
*Preseptal/Orbital [[cellulitis]]
*[[Keratitis]]


===Bacterial Causes===
===Allergic conjunctivitis===
A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with ''[[Neisseria gonorrhoeae]]'' should be suspected if the discharge is particularly thick and copious.
[[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>
===Viral Causes===
*Viral conjunctivitis
A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.
*Bacterial conjunctivitis
 
===Keratoconjunctivitis sicca===
===Trachoma===
[[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>
Scarring of the tarsal conjunctiva suggests [[trachoma]], especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.
*Allergic conjunctivitis (atopic and vernal keratoconjunctivitis)
 
*[[Blepharitis]]
===Dry Eye Variants===
*[[Bell's palsy]]
Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.
*[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]
 
*[[Thyroid]] ophthalmopathy
===Serious Illnesses such as [[Glaucoma]], [[Uveitis]], [[Keratitis]] and even [[Meningitis]] or [[Caroticocavernous fistula]]===
===Superior limbic keratoconjunctivitis===
 
[[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>
Other symptoms including pain, blurring of vision and [[photophobia]] should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge.  Mild photophobia is common.  However, if any of these symptoms are prominent, it is important to exclude other diseases such as [[glaucoma]], [[uveitis]], [[keratitis]] and even [[meningitis]] or [[caroticocavernous fistula]].
*Infective conjunctivitis
*[[Allergic conjunctivitis]]  
*[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]  
*Floppy eyelid syndrome
*Thyroid ophthalmopathy
*Ocular surface squamous [[neoplasia]]
*[[Sebaceous gland carcinoma]]
*[[Episcleritis]]
*[[Trachoma]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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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

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]

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]

Superior limbic keratoconjunctivitis

Superior limbic keratoconjunctivitis (SLK) is chronic condition with remission and exacerbations, and it must be differentiated from:[9]

References

  1. ↑ 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. ↑ 2.0 2.1 American Academy of ophthalmology (2016) http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.

] Template:WH Template:WS

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