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==Overview==
==Overview==
[[Image:Pinkeye_twoangles.jpg|thumb|left|225px|Eyes with conjunctivitis]]
[[Image:Pinkeye_twoangles.jpg|thumb|left|225px|Eyes with conjunctivitis]]
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include exposure history, recent infection, contact lens use, history of [[sexually transmitted disease|sexually transmitted disease (STD)]], history of [[autoimmune diseases]], and any specific environmental or work-related exposure.
The history of a patient with conjunctivitis should include a thorough [[ocular]], [[medical]] and [[medication]] history. The history establish whether the condition is [[acute]], [[subacute]], [[chronic]] or recurrent, and whether it is associated with any specific environmental or work-related exposure.Complete history will help determine the correct [[therapy]]. A detailed and thorough history from the patient is necessary.
The symptoms of conjunctivitis differ based on the cause of the [[inflammation]]. [[Redness]], [[excessive tearing]], and [[irritation]] are symptoms common to all forms of conjunctivitis. [[Photophobia]], [[itching]], [[mucopurulent]] or non-purulent discharge, [[chemosis]], burning eyes, [[blurred vision]] and [[eyelid]] [[swelling]] are variable.<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><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>
The [[symptoms]] of conjunctivitis differ based on the cause of the [[inflammation]]. [[Redness]], [[excessive tearing]], and [[irritation]] are symptoms common to all forms of conjunctivitis. [[Photophobia]], [[itching]], [[mucopurulent]] or non-purulent discharge, [[chemosis]], burning eyes, [[blurred vision]] and [[eyelid]] [[swelling]] are variable.<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><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>
 


==History==
==History==
Complete history will help determine the correct therapy. A detailed and thorough history from the patient is necessary.
The [[history]] of a patient with conjunctivitis should include a thorough [[ocular]], [[medical]] and [[medication]] history. The history establish whether the condition is [[acute]], [[subacute]], [[chronic]] or recurrent, and whether it is associated with any specific environmental or work-related [[exposure]].Complete history will help determine the correct [[therapy]]. A detailed and thorough history from the patient is necessary.<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>
The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. The history establish whether the condition is acute, subacute, chronic or recurrent, and whether it is associated with any specific environmental or work-related exposure.<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>


===Viral Conjunctivitis===
===Viral Conjunctivitis===
Line 18: Line 16:
*Recent [[upper respiratory infection|upper respiratory infection (URI)]]  
*Recent [[upper respiratory infection|upper respiratory infection (URI)]]  
*Swimming in contaminated pools
*Swimming in contaminated pools
*Contact lens use
*[[Contact lens]] use


===Bacterial Conjunctivitis===
===Bacterial Conjunctivitis===
Specific areas of focus when obtaining a history from the patient include:<ref name="pmid17585426">{{cite journal| author=| title=Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. | journal=Prescrire Int | year= 2007 | volume= 16 | issue= 89 | pages= 120-1 | pmid=17585426 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17585426  }} </ref>
Specific areas of focus when obtaining a history from the patient include:<ref name="pmid17585426">{{cite journal| author=| title=Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. | journal=Prescrire Int | year= 2007 | volume= 16 | issue= 89 | pages= 120-1 | pmid=17585426 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17585426  }} </ref>
*History of [[sexually transmitted disease|sexually transmitted disease (STD)]]
*History of [[sexually transmitted disease|sexually transmitted disease (STD)]]
*Exposure history (contaminated fingers, [[oculogenita]]l spread, and contaminated [[fomites]])
*Exposure history (contaminated fingers, oculogenital spread, and contaminated fomites)
*Contact lens use
*[[Contact lens]] use
*Chronic use of topical medications
*Chronic use of [[topical]] medications


===Neonatal Conjunctivitis===
===Neonatal Conjunctivitis===
Line 34: Line 32:
===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
Specific areas of focus when obtaining a history from the patient include:<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><ref name="pmid18282546">{{cite journal| author=Jun J, Bielory L, Raizman MB| title=Vernal conjunctivitis. | journal=Immunol Allergy Clin North Am | year= 2008 | volume= 28 | issue= 1 | pages= 59-82, vi | pmid=18282546 | doi=10.1016/j.iac.2007.12.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18282546  }} </ref><ref name="pmid15245362">{{cite journal| author=Bonini S| title=Atopic keratoconjunctivitis. | journal=Allergy | year= 2004 | volume= 59 Suppl 78 | issue=  | pages= 71-3 | pmid=15245362 | doi=10.1111/j.1398-9995.2004.00570.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245362  }} </ref>
Specific areas of focus when obtaining a history from the patient include:<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><ref name="pmid18282546">{{cite journal| author=Jun J, Bielory L, Raizman MB| title=Vernal conjunctivitis. | journal=Immunol Allergy Clin North Am | year= 2008 | volume= 28 | issue= 1 | pages= 59-82, vi | pmid=18282546 | doi=10.1016/j.iac.2007.12.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18282546  }} </ref><ref name="pmid15245362">{{cite journal| author=Bonini S| title=Atopic keratoconjunctivitis. | journal=Allergy | year= 2004 | volume= 59 Suppl 78 | issue=  | pages= 71-3 | pmid=15245362 | doi=10.1111/j.1398-9995.2004.00570.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245362  }} </ref>
*Family history of [[atopic disease]] such as:
*Family history of atopic disease such as:
**[[Allergic rhinitis]]
**[[Allergic rhinitis]]
**[[Bronchial asthma]]  
**[[Bronchial asthma]]  
Line 47: Line 45:
*Contact lens use
*Contact lens use
*History of neurologic conditions ([[stroke]], [[Bell's palsy]], [[Parkinson's]], [[trigeminal nerve]] problem)
*History of neurologic conditions ([[stroke]], [[Bell's palsy]], [[Parkinson's]], [[trigeminal nerve]] problem)
*Prior eye surgery
*Prior eye [[surgery]]


===Superior limbic keratoconjunctivitis===
===Superior limbic keratoconjunctivitis===
Line 55: Line 53:


==Symptoms==
==Symptoms==
The symptoms of conjunctivitis differ based on the cause of the [[inflammation]]. [[Redness]], [[excessive tearing]], and [[irritation]] are symptoms common to all forms of conjunctivitis. [[Photophobia]], [[itching]], [[mucopurulent]] or non-purulent discharge, [[chemosis]], burning eyes, [[blurred vision]] and [[eyelid]] [[swelling]] are variable.
The [[symptoms]] of conjunctivitis differ based on the cause of the [[inflammation]]. [[Redness]], [[excessive tearing]], and [[irritation]] are symptoms common to all forms of conjunctivitis. [[Photophobia]], [[itching]], [[mucopurulent]] or non-purulent discharge, [[chemosis]], burning eyes, [[blurred vision]] and [[eyelid]] [[swelling]] are variable.


===Viral Conjunctivitis===
===Viral Conjunctivitis===
Line 85: Line 83:
*Severe pain level
*Severe pain level
*[[Purulent]] discharge
*[[Purulent]] discharge
*Subconjunctival [[hemorrhaging]]
*Subconjunctival [[hemorrhage]]
   
   
===Bacterial Conjunctivitis===
===Bacterial Conjunctivitis===

Revision as of 15:13, 1 July 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Sara Mehrsefat, M.D. [3]

Overview

Eyes with conjunctivitis

The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. The history establish whether the condition is acute, subacute, chronic or recurrent, and whether it is associated with any specific environmental or work-related exposure.Complete history will help determine the correct therapy. A detailed and thorough history from the patient is necessary. The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable.[1][2]

History

The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. The history establish whether the condition is acute, subacute, chronic or recurrent, and whether it is associated with any specific environmental or work-related exposure.Complete history will help determine the correct therapy. A detailed and thorough history from the patient is necessary.[1]

Viral Conjunctivitis

Specific areas of focus when obtaining a history from the patient include:[2]

Bacterial Conjunctivitis

Specific areas of focus when obtaining a history from the patient include:[3]

Neonatal Conjunctivitis

Specific areas of focus when obtaining a history from the patient include:[4]

Allergic Conjunctivitis

Specific areas of focus when obtaining a history from the patient include:[5][6][7]

Keratoconjunctivitis Sicca

Specific areas of focus when obtaining a history from the patient include:[8][9]

Superior limbic keratoconjunctivitis

Specific areas of focus when obtaining a history from the patient include:[10]

  • Prolonged condition with gradual clearing
  • Often have seen numerous eye specialists

Symptoms

The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable.

Viral Conjunctivitis

Adenovirus is the most common cause of viral conjunctivitis. It has Acute or subacute onset, and often occurs in community epidemics. Both eyes may be affected simultaneously, or the second eye may become involved a few days after the first eye. Symptoms of viral conjunctivitis may include the following:[11]

Pharyngoconjunctival Fever

Epidemic Keratoconjunctivitis

Acute Hemorrhagic Conjunctivitis

Acute hemorrhagic conjunctivitis (AHC) is a rapidly progressive and contagious viral infection.The infection resolves within 5-7 days, during which the symptoms of pain and irritation are present. Symptoms of acute hemorrhagic conjunctivitis may include the following:[12]

Bacterial Conjunctivitis

Bacterial conjunctivitis has Hyperacute, acute, and chronic onset. Symptoms of bacterial conjunctivitis may include the following: [13]

Hyperacute Bacterial Conjunctivitis

Hyperacute bacterial conjunctivitis is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and rapid progression. Symptoms of Hyperacute Bacterial conjunctivitis may include the following:[14]

Neonatal Conjunctivitis

Symptoms of various types of neonatal conjunctivitis or ophthalmia neonatorum may include the following:[15][16]

Gonococcal Conjunctivitis

Gonococcal conjunctivitis is more severe than chlamydial conjunctivitis. The incubation period is 2-5 days. It is usually bilateral. Symptoms of gonococcal conjunctivitis may include the following:

Chlamydial Conjunctivitis

It has a later onset than gonococcal conjunctivitis. The incubation period is 5-14 days and the colonization of the eye after birth does not always result in infection. Symptoms of chlamydial conjunctivitis may include the following:

Chemical conjunctivitis

Chemical conjunctivitis usually occurs within 24 hours of instillation of silver nitrate solution and resolves spontaneously within a few days. Symptoms of 'chemical conjunctivitis may include the following:

  • Eyelids swelling
  • Redness

Allergic Conjunctivitis

Symptoms of allergic conjunctivitis may include the following:[17]

Keratoconjunctivitis Sicca

Symptoms of keratoconjunctivitis sicca (dry eye syndrome) may include the following:[18]

Superior Limbic Keratoconjunctivitis

Symptoms of superior limbic keratoconjunctivitis may include the following:[19]

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 2.0 2.1 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  3. ↑ "Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective". Prescrire Int. 16 (89): 120–1. 2007. PMID 17585426.
  4. ↑ Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis". J Infect Dis. 153 (5): 862–9. PMID 3084664.
  5. ↑ 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.
  6. ↑ Jun J, Bielory L, Raizman MB (2008). "Vernal conjunctivitis". Immunol Allergy Clin North Am. 28 (1): 59–82, vi. doi:10.1016/j.iac.2007.12.007. PMID 18282546.
  7. ↑ Bonini S (2004). "Atopic keratoconjunctivitis". Allergy. 59 Suppl 78: 71–3. doi:10.1111/j.1398-9995.2004.00570.x. PMID 15245362.
  8. ↑ Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). "Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies". Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
  9. ↑ Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands". Cornea. 17 (6): 584–9. PMID 9820935.
  10. ↑ 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.
  11. ↑ Drug and Therapeutics Bulletin (2011). "Management of acute infective conjunctivitis". Drug Ther Bull. 49 (7): 78–81. doi:10.1136/dtb.2011.02.0043. PMID 21733975.
  12. ↑ Yin-Murphy M (1976). "Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)". Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
  13. ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  14. ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
  15. ↑ 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.
  16. ↑ Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
  17. ↑ Kumar S (2009). "Vernal keratoconjunctivitis: a major review". Acta Ophthalmol. 87 (2): 133–47. doi:10.1111/j.1755-3768.2008.01347.x. PMID 18786127.
  18. ↑ Zoukhri D (2006). "Effect of inflammation on lacrimal gland function". Exp Eye Res. 82 (5): 885–98. doi:10.1016/j.exer.2005.10.018. PMC 1361268. PMID 16309672.
  19. ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.


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