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:[1][2]
- 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:[3]
- Swollen, edematous eyelid
- Eye pain in palpation
- Bulbar conjunctiva hemorrhage
Bacterial Conjunctivitis
Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:[4][5]
- 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:[6]
- Neisseria gonorrhea
- Chemosis
- Severe lid edema and
- Mucopurulent discharge
- Corneal involvement (diffuse epithelial edema, ulceration, corneal perforation, and endophthalmitis
- Chlamydia trachomatis
- Chemical
- Mild conjunctival injection
- Tearing
Allergic Conjunctivitis
Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:[7]
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:[8][9]
- 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:[10]
- Hyperemia
- Micro-papillary reaction in the upper tarsal conjunctiva,
- 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.[11]
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One eye with conjunctivitis. -
Bacterial Conjunctivitis -
Chemical Conjunctivitis
.jpg)
(Images shown below are courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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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.
References
- ↑ 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.
- ↑ 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.
- ↑ Yin-Murphy M (1976). "Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)". Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
- ↑ 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.
- ↑ Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands". Cornea. 17 (6): 584–9. PMID 9820935.
- ↑ Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). "Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies". Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
- ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages/