Conjunctivitis differential diagnosis

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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 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

Neonatal conjunctivitis

Neonatal conjunctivitis must be differentiated from:

• Dacrocysitis
• Congenital glaucoma
• Nasolacrimal duct obstruction
• Preseptal/Orbital cellulitis
• keratitis

Allergic conjunctivitis

Allergic conjunctivitis must be differentiated from:

• Viral conjunctivitis
• Bacterial conjunctivitis

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

References

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