Conjunctivitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Conjunctivitis}} | {{Conjunctivitis}} | ||
{{CMG}} {{AE}} {{SaraM}} | {{CMG}}; {{AE}} {{SaraM}} | ||
==Overview== | ==Overview== | ||
Laboratory tests are not often required in patients with mild conjunctivitis. | Laboratory tests are not often required in patients with mild conjunctivitis. Conjunctival cultures are generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[mucopurulent 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== | ||
Laboratory tests usually are not required in patients with mild conjunctivitis. However, specimens for [[bacterial]] | 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]] with [[mucopurulent discharge]], chronic conjunctivitis, and recurrent conjunctivitis. Cultures also should be obtained in patients who do not respond to treatment.<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> | ||
===Viral Conjunctivitis=== | ===Viral Conjunctivitis=== | ||
In general, | 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 | Swabs for [[bacterial]] culture is generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[mucopurulent 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 | 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 [[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 | *Enzyme immuno-assays for chlamydia organisms | ||
====Gonococcal Infection==== | ====Gonococcal Infection==== | ||
Laboratory studies for | Laboratory studies for gonococca 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 | ||
| Line 39: | Line 39: | ||
*[[Skin testing]] (may provide definitive diagnosis) | *[[Skin testing]] (may provide definitive diagnosis) | ||
===Keratoconjunctivitis Sicca=== | ===Keratoconjunctivitis Sicca=== | ||
[[ | Diagnosis of [[keratoconjunctivitis sicca|keratoconjunctivitis sicca (dry eye syndrome)]] is generally made by the combination of history, physical examination, and labratory findings. | ||
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) | ||
| Line 53: | Line 53: | ||
*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]], | [[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== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:43, 18 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 recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe mucopurulent 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 with mucopurulent discharge, chronic conjunctivitis, and 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]
- Conjunctival scraping for polymerase chain reaction (PCR) (PCR testing for HSV is more sensitive than viral culture)
- Viral culture of corneal epithelial cells for HSV
Bacterial Conjunctivitis
Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required. Swabs for bacterial culture is generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe mucopurulent discharge, and cases suspicious for gonococcal or chlamydial infection.[5][6]
Chlamydial Infection
Laboratory studies for chlamydial conjunctivitis should include the following:[7]
- Conjunctival scraping for 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 DNA hybridization assays
- Direct fluorescent monoclonal antibody staining of smears
- Enzyme immuno-assays for chlamydia organisms
Gonococcal Infection
Laboratory studies for gonococca conjunctivitis should include the following:[8]
- Conjunctival scraping for gram staining of specimens for gram-negative intra-cellular diplococci
- Special cultures for neisseria species on chocolate agar or Thayer-Martin
Neonatal Conjunctivitis
Laboratory studies for neonatal conjunctivitis should include the following:[9]
- Conjunctival scraping for gram staining or giemsa staining
- Conjunctival scraping for Polymerase chain reaction (PCR) for chlamydia, gonorrhea, and HSV
- Special cultures for neisseria species on chocolate agar or Thayer-Martin
- Culture on blood agar
- Viral culture of corneal epithelial cells for HSV (cornea is involvement)
Allergic Conjunctivitis
Most cases are mild, and the patient just needs reassurance. Laboratory studies for allergic conjunctivitis should include the following:[10]
- Superficial conjunctival scraping may reveal eosinophils (severe cases)
- Measurement of tear levels of various inflammatory mediators (such as IgE, histamine, and tryptase)
- Skin testing (may provide definitive diagnosis)
Keratoconjunctivitis Sicca
Diagnosis of keratoconjunctivitis sicca (dry eye syndrome) is generally made by the combination of history, physical examination, and labratory findings. 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)
- Antinuclear antibody (ANA)
- Rheumatoid factor (RF)
- Anti Ro antibody (SS-A)
- Anti La antibody]] (SS-B)
- Salivary gland protein 1 antibody (SP-1)
- Carbonic anhydrase 6 antibody (CA6)
- Parotid secretory protein antibody (PSP)
- 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]
- Thyroid-stimulating hormone (TSH)
- Free thyroxine (T4)
- Anti thyroid peroxidase antibody]
- Antithyroglobulin antibody
References
- ↑ 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.
- ↑ 2.0 2.1 Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.
- ↑ 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.
- ↑ 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.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ 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.
- ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
- ↑ Passons GA, Wood TO (1984). "Conjunctival resection for superior limbic keratoconjunctivitis". Ophthalmology. 91 (8): 966–8. PMID 6493706.