Conjunctivitis laboratory findings: Difference between revisions

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==Overview==
==Overview==
Laboratory tests are not often required in patients with mild conjunctivitis. [[Conjunctival]] cultures are generally reserved for cases of suspected infectious neonatal conjunctivitis  ([[ophthalmia neonatorum]]), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for ''[[gonococcal]]'' or ''[[chlamydial]] infection.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid17491982">{{cite journal| author=Wood M| title=Conjunctivitis: diagnosis and management. | journal=Community Eye Health | year= 1999 | volume= 12 | issue= 30 | pages= 19-20 | pmid=17491982 | doi= | pmc=1706007 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17491982  }} </ref>
Laboratory tests are not often required in patients with mild conjunctivitis. [[Conjunctival]] cultures are generally reserved for cases of suspected infectious neonatal conjunctivitis  ([[ophthalmia neonatorum]]), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for [[gonococcal]] or [[chlamydial infection.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid17491982">{{cite journal| author=Wood M| title=Conjunctivitis: diagnosis and management. | journal=Community Eye Health | year= 1999 | volume= 12 | issue= 30 | pages= 19-20 | pmid=17491982 | doi= | pmc=1706007 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17491982  }} </ref>


==Laboratory Findings==
==Laboratory Findings==
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In general, [[viral]] conjunctivitis is diagnosed based on clinical features alone. Laboratory studies for viral conjunctivitis should include the following:<ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref>
In general, [[viral]] conjunctivitis is diagnosed based on clinical features alone. Laboratory studies for viral conjunctivitis should include the following:<ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref>
*Conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]] (PCR testing for HSV is more sensitive than viral culture)
*Conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]] (PCR testing for HSV is more sensitive than viral culture)
*Viral culture of [[corneal]] [[epithelial cells]] for [[HSV]]  
*Viral culture of corneal epithelial cells for [[HSV]]  
===Bacterial Conjunctivitis===
===Bacterial Conjunctivitis===
[[Acute]] [[bacterial]] conjunctivitis is usually self-limited and laboratory tests usually are not required.  
Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required.  
Swabs for [[bacterial]] culture is generally reserved for cases of suspected infectious neonatal conjunctivitis ([[ophthalmia neonatorum]]), recurrent conjunctivitis, conjunctivitis recalcitrant to [[therapy]], conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for ''[[gonococcal]]'' or ''[[chlamydial]] infection.<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="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref>
Swabs for [[bacterial]] culture is generally reserved for cases of suspected infectious neonatal conjunctivitis ([[ophthalmia neonatorum]]), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for ''[[gonococcal]]'' or ''[[chlamydial]] infection.<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="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref>
====''Chlamydial'' Infection====
====''Chlamydial'' Infection====
Laboratory studies for ''[[chlamydial]]'' conjunctivitis should include the following:<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref>
Laboratory studies for chlamydial conjunctivitis should include the following:<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref>
*Conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]]
*Conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]]
*[[Conjunctival]] scraping for [[gram staining]] or [[giemsa]] staining (help characterize the conjunctival [[inflammatory response]] and rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens)
*[[Conjunctival]] scraping for [[gram staining]] or giemsa staining (help characterize the conjunctival [[inflammatory response]] and rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens)
*Conjunctival scraping for [[DNA hybridization]] assays  
*Conjunctival scraping for [[DNA hybridization]] assays  
*Direct [[fluorescent]] [[monoclonal antibody]] [[staining]] of smears
*Direct fluorescent monoclonal antibody staining of smears
*[[Enzyme]] immuno-assays for ''chlamydia'' [[organisms]]
*Enzyme immuno-assays for chlamydia [[organisms]]
====''Gonococcal'' Infection====
====''Gonococcal'' Infection====
Laboratory studies for ''[[chlamydial]]'' conjunctivitis should include the following:<ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref>
Laboratory studies for [[chlamydial]] conjunctivitis should include the following:<ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref>
*[[Conjunctival]] scraping for [[gram staining]] of specimens for [[gram-negative]] intra-cellular [[diplococci]]
*[[Conjunctival]] scraping for [[gram staining]] of specimens for [[gram-negative]] intra-cellular [[diplococci]]
*Special cultures for ''[[neisseria]]'' species on [[chocolate agar]] or Thayer-Martin
*Special cultures for [[neisseria]] species on [[chocolate agar]] or Thayer-Martin
===Neonatal Conjunctivitis===
===Neonatal Conjunctivitis===
Laboratory studies for neonatal conjunctivitis should include the following:<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>
Laboratory studies for neonatal conjunctivitis should include the following:<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>
*Conjunctival scraping for [[gram staining]] or [[giemsa]] staining
*Conjunctival scraping for [[gram staining]] or [[giemsa]] staining
*Conjunctival scraping for [[Polymerase chain reaction|Polymerase chain reaction (PCR)]] for ''[[chlamydia]]'', ''[[gonorrhea]]'', and ''[[HSV]]''
*Conjunctival scraping for [[Polymerase chain reaction|Polymerase chain reaction (PCR)]] for ''[[chlamydia]]'', ''[[gonorrhea]]'', and ''[[HSV]]''
*Special cultures for ''[[neisseria]]'' species on [[chocolate agar]] or Thayer-Martin
*Special cultures for [[neisseria]] species on [[chocolate agar]] or Thayer-Martin
*Culture on [[blood agar]]
*Culture on [[blood agar]]
*Viral culture of [[corneal]] [[epithelial cells]] for [[HSV]] (cornea is involvement)
*Viral culture of corneal epithelial cells for [[HSV]] (cornea is involvement)
===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
Most cases are mild, and the patient just needs [[reassurance]]. Laboratory studies for allergic conjunctivitis should include the following:<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>
Most cases are mild, and the patient just needs [[reassurance]]. Laboratory studies for allergic conjunctivitis should include the following:<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>
Line 41: Line 41:
[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]], is essentially a clinical diagnosis, made by combining information obtained from the history, physical examination and performing one or more diagnostic tests to lend additional objectivity to the diagnosis.
[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]], is essentially a clinical diagnosis, made by combining information obtained from the history, physical examination and performing one or more diagnostic tests to lend additional objectivity to the diagnosis.
Laboratory studies for keratoconjunctivitis sicca should include the following:<ref name="pmid19668387">{{cite journal| author=Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E| title=The challenge of dry eye diagnosis. | journal=Clin Ophthalmol | year= 2008 | volume= 2 | issue= 1 | pages= 31-55 | pmid=19668387 | doi= | pmc=2698717 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19668387  }} </ref><ref name="pmid26766898">{{cite journal| author=Beckman KA, Luchs J, Milner MS| title=Making the diagnosis of Sjögren's syndrome in patients with dry eye. | journal=Clin Ophthalmol | year= 2016 | volume= 10 | issue=  | pages= 43-53 | pmid=26766898 | doi=10.2147/OPTH.S80043 | pmc=4699514 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26766898  }} </ref>
Laboratory studies for keratoconjunctivitis sicca should include the following:<ref name="pmid19668387">{{cite journal| author=Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E| title=The challenge of dry eye diagnosis. | journal=Clin Ophthalmol | year= 2008 | volume= 2 | issue= 1 | pages= 31-55 | pmid=19668387 | doi= | pmc=2698717 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19668387  }} </ref><ref name="pmid26766898">{{cite journal| author=Beckman KA, Luchs J, Milner MS| title=Making the diagnosis of Sjögren's syndrome in patients with dry eye. | journal=Clin Ophthalmol | year= 2016 | volume= 10 | issue=  | pages= 43-53 | pmid=26766898 | doi=10.2147/OPTH.S80043 | pmc=4699514 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26766898  }} </ref>
*Tear [[osmolarity]] (best single diagnostic test)
*Tear osmolarity (best single diagnostic test)
*Tear film [[interferometry]] (measure lipid layer thickness)
*Tear film interferometry (measure lipid layer thickness)
*[[Sjö test]] (Serology for circulating [[autoantibodies]])
*[[Sjö test]] (Serology for circulating [[autoantibodies]])
**[[Antinuclear antibody|Antinuclear antibody (ANA)]]
**[[Antinuclear antibody|Antinuclear antibody (ANA)]]
Line 48: Line 48:
**Anti Ro antibody (SS-A)  
**Anti Ro antibody (SS-A)  
**Anti La antibody]] (SS-B)  
**Anti La antibody]] (SS-B)  
**[[Salivary gland]] protein 1 [[antibody]] (SP-1)  
**Salivary gland protein 1 antibody (SP-1)  
**[[Carbonic anhydrase]] 6 antibody (CA6)
**Carbonic anhydrase 6 antibody (CA6)
**[[Parotid]] secretory protein antibody (PSP)
**Parotid secretory protein antibody (PSP)
*Conjunctival [[biopsy]] with light [[microscopic]] as well as [[immunofluorescent]] (any patients with significant [[chronic]] conjunctivitis)
*Conjunctival [[biopsy]] with light microscopic as well as immunofluorescent (any patients with significant [[chronic]] conjunctivitis)
===Superior Limbic Keratoconjunctivitis===
===Superior Limbic Keratoconjunctivitis===
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] has been associated with [[thyroid dysfunction]], therefore, Laboratory studies for superior limbic keratoconjunctivitis should include the following:<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref><ref name="pmid6493706">{{cite journal| author=Passons GA, Wood TO| title=Conjunctival resection for superior limbic keratoconjunctivitis. | journal=Ophthalmology | year= 1984 | volume= 91 | issue= 8 | pages= 966-8 | pmid=6493706 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6493706  }} </ref>
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] has been associated with [[thyroid dysfunction]], therefore, Laboratory studies for superior limbic keratoconjunctivitis should include the following:<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref><ref name="pmid6493706">{{cite journal| author=Passons GA, Wood TO| title=Conjunctival resection for superior limbic keratoconjunctivitis. | journal=Ophthalmology | year= 1984 | volume= 91 | issue= 8 | pages= 966-8 | pmid=6493706 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6493706  }} </ref>
*[[Thyroid-stimulating hormone|Thyroid-stimulating hormone (TSH)]]
*[[Thyroid-stimulating hormone|Thyroid-stimulating hormone (TSH)]]
*Free [[thyroxine|thyroxine (T4)]]
*Free [[thyroxine|thyroxine (T4)]]
*Anti [[thyroid peroxidase]] [[antibody]]
*Anti thyroid peroxidase antibody]
*[[Antithyroglobulin antibody]]
*[[Antithyroglobulin antibody]]
==References==
==References==

Revision as of 18:01, 11 July 2016

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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

Laboratory tests are not often required in patients with mild conjunctivitis. Conjunctival cultures are generally reserved for cases of suspected infectious neonatal conjunctivitis (ophthalmia neonatorum), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe purulent discharge, and cases suspicious for gonococcal or [[chlamydial infection.[1][2]

Laboratory Findings

Laboratory tests usually are not required in patients with mild conjunctivitis. However, specimens for bacterial cultures should be obtained in patients who have severe inflammation (hyperacute purulent conjunctivitis), chronic, or recurrent conjunctivitis. Cultures also should be obtained in patients who do not respond to treatment.[2]

Viral Conjunctivitis

In general, viral conjunctivitis is diagnosed based on clinical features alone. Laboratory studies for viral conjunctivitis should include the following:[3][4]

Bacterial Conjunctivitis

Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required. Swabs for bacterial culture is generally reserved for cases of suspected infectious neonatal conjunctivitis (ophthalmia neonatorum), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe purulent discharge, and cases suspicious for gonococcal or chlamydial infection.[5][6]

Chlamydial Infection

Laboratory studies for chlamydial conjunctivitis should include the following:[7]

Gonococcal Infection

Laboratory studies for chlamydial conjunctivitis should include the following:[8]

Neonatal Conjunctivitis

Laboratory studies for neonatal conjunctivitis should include the following:[9]

Allergic Conjunctivitis

Most cases are mild, and the patient just needs reassurance. Laboratory studies for allergic conjunctivitis should include the following:[10]

Keratoconjunctivitis Sicca

Keratoconjunctivitis sicca (dry eye syndrome), is essentially a clinical diagnosis, made by combining information obtained from the history, physical examination and performing one or more diagnostic tests to lend additional objectivity to the diagnosis. Laboratory studies for keratoconjunctivitis sicca should include the following:[11][12]

  • Tear osmolarity (best single diagnostic test)
  • Tear film interferometry (measure lipid layer thickness)
  • Sjö test (Serology for circulating autoantibodies)
  • Conjunctival biopsy with light microscopic as well as immunofluorescent (any patients with significant chronic conjunctivitis)

Superior Limbic Keratoconjunctivitis

Superior limbic keratoconjunctivitis (SLK) has been associated with thyroid dysfunction, therefore, Laboratory studies for superior limbic keratoconjunctivitis should include the following:[13][14]

References

  1. ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  2. ↑ 2.0 2.1 Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.
  3. ↑ Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH (2015). "The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil". Clinics (Sao Paulo). 70 (11): 748–50. doi:10.6061/clinics/2015(11)06. PMC 4642493. PMID 26602522.
  4. ↑ Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
  5. ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  6. ↑ 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.
  7. ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  8. ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E (2008). "The challenge of dry eye diagnosis". Clin Ophthalmol. 2 (1): 31–55. PMC 2698717. PMID 19668387.
  12. ↑ Beckman KA, Luchs J, Milner MS (2016). "Making the diagnosis of Sjögren's syndrome in patients with dry eye". Clin Ophthalmol. 10: 43–53. doi:10.2147/OPTH.S80043. PMC 4699514. PMID 26766898.
  13. ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
  14. ↑ Passons GA, Wood TO (1984). "Conjunctival resection for superior limbic keratoconjunctivitis". Ophthalmology. 91 (8): 966–8. PMID 6493706.


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