Conjunctivitis physical examination

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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

Physical examination of patients with conjunctivitis is usually remarkable for swollen eyelid, epiphora, hyperemia, and muco-purulent or watery discharge.

Physical Examination

Viral Conjunctivitis

Patients with viral conjunctivitis usually appear febrile, and they have Preauricular adenopathy. Ophthalmologic examination of patients with viral conjunctivitis is usually remarkable for:

• Epiphora
• Hyperemia
• Chemosis
• Follicular conjunctival reaction
• Pseudomembranous (occasionally)
• Cicatricial conjunctival reaction
• Edematous and ecchymotic eyelids
• Corneal epithelial defect (severe cases)

Acute Hemorrhagic Conjunctivitis

Ophthalmologic examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:

• Swollen, edematous eyelid
• Eye pain in palpation
• Bulbar conjunctiva hemorrhage

Bacterial Conjunctivitis

Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:

• Bulbar conjunctival injection
• Palpebral conjunctival papillary reaction
• Muco-purulent or watery discharge
• Chemosis
• Lid erythema

Neonatal Conjunctivitis

Ophthalmologic examination of patients with neonatal conjunctivitis is usually remarkable for:

• Neisseria gonorrhea
  • Chemosis
  • Severe lid edema and
  • Mucopurulent discharge
  • Corneal involvement (diffuse epithelial edema, ulceration, corneal perforation, and endophthalmitis
• Chlamydia trachomatis
  • Mild hyperemia
  • Mucoid discharge
  • Chemosis
  • Pseudomembrane formation
• Chemical
  • Mild conjunctival injection
  • Tearing

Allergic Conjunctivitis

Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:

• Bilateral conjunctival injection
• Chemosis]
• Watery discharge, or mild mucous discharge

Keratoconjunctivitis Sicaa

Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, eyelashes, conjunctiva, cornea, and tear film. Examination of patients with keratoconjunctivitis sicaa is usually remarkable for:

• More or less pronounced conjunctival redness
• Damage to the ocular surface with punctate epithelial erosions (superficial punctate keratitis)
• Thickened eyelid margins and telangiectasia (signs of meibomian gland dysfunction)
• Meibomian gland orifices are obstructed with a cloudy, granular or solid secretion (expressed by exerting considerable pressure on the lower lid)
• Blepharitis (associated with meibomian gland dysfunction)
• Meibomitis (inflammation of the meibomian glands)

Superior Limbic Keratoconjunctivitis

Ophthalmologic examination of patients with superior limbic keratoconjunctivitis is usually remarkable for:

• Micro-papillary reaction in the upper tarsal conjunctiva,
• Hyperemia
• Thickening of the superior bulbar conjunctiva
• Ciliary injection in the upper bulbar conjunctiva
• Corneal erosions in the upper quadrants
• Diffuse superficial corneal erosions
• Eyelid edema

Images

The following are gross images associated with rheumatic fever.

• 
  One eye with conjunctivitis.
• 
  Bacterial Conjunctivitis
• 
  Chemical Conjunctivitis

(Images shown below are courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

• 
  Conjunctivitis: Note inflamed conjunctiva of sclera and reflection onto underside of eyelid.
• 
  Conjunctivitis: Marked bilateral inflammation involving conjunctiva that covers sclera and under surface of eyelid. Thick exudate can also be seen.
• 
  Conjunctivitis: Inflammation of conjunctiva covering sclera and under surface of eyelid.