Conjunctivitis differential diagnosis: Difference between revisions
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===Bacterial Conjunctivitis=== | ===Bacterial Conjunctivitis=== | ||
A purulent 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. | A purulent 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: | ||
* Viral conjunctivitis | * Viral conjunctivitis | ||
*[[keratoconjunctivitis sicca]] | *[[keratoconjunctivitis sicca]] | ||
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*[[iritis]] | *[[iritis]] | ||
*[[keratitis]]. | *[[keratitis]]. | ||
*[[Neisseria | *[[Episcleritis]] | ||
*[[Scleritis]] | |||
*[[Neisseria meningitis]] is also in the differential, and it is important to consider as it can lead to fatal 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, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy. | A diffuse, highly contagious, characterized by watery discharge, 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. Viral Conjunctivitis must be differentiated from: | ||
* | *Keratoconjunctivitis | ||
*[[Nasolacrimal duct obstruction]] | *[[Nasolacrimal duct obstruction]] | ||
*[[Foreign body]] | *[[Foreign body]] | ||
Revision as of 13:06, 27 June 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicrosopy, laboratory tests are often necessary to determine the underlying pathophysiology with certainty. perform an eye examination can help to differentiating Conjunctivitis from other medical conditions.
Bacterial Conjunctivitis
A purulent 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:
- Viral conjunctivitis
- keratoconjunctivitis sicca
- glaucoma
- Blepharitis
- uveitis
- iritis
- keratitis.
- Episcleritis
- Scleritis
- Neisseria meningitis is also in the differential, and it is important to consider as 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, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy. Viral Conjunctivitis must be differentiated from:
- Keratoconjunctivitis
- Nasolacrimal duct obstruction
- Foreign body
- Keratitis
- Uveitis
- Pharyngoconjunctival fever
Allergic conjunctivitis
Allergic conjunctivitis must be differentiated from:
Allergic conjunctivitis has a protracted course, with the severity of symptoms waxing and waning throughout the allergy season. As recurrences within a short period of time are unlikely with bacterial or viral conjunctivitis.
Keratoconjunctivitis sicca
Dry eye syndrome (DES), or keratoconjunctivitis sicca must be differentiated from:
- Allergic conjunctivitis (Atopic, and vernal keratoconjunctivitis)
- Blepharitis
- Bell Palsy
- Superior limbic keratoconjunctivitis
- Thyroid ophthalmopathy
Superior limbic keratoconjunctivitis
Superior limbic keratoconjunctivitis is chronic condition with remission and exacerbations, and it must be differentiated from:
- Infective conjunctivitis
- Allergic conjunctivitis
- dry eye syndrome (DES)
- Thyroid ophthalmopathy
- Ocular surface squamous neoplasia
- Sebaceous gland carcinoma