Conjunctivitis laboratory findings
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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 as conjunctivitis is often treated empirically. Obtaining conjunctival cultures is generally reserved for cases of suspected infectious neonatal conjunctivitis, recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe purulent discharge, and cases suspicious for gonococcal or chlamydial infection.
Laboratory Findings
Laboratory tests usually are not required in patients with mild conjunctivitis of suspected viral, bacterial or allergic origin. However, specimens for bacterial cultures is generally reserved for cases of suspected infectious neonatal conjunctivitis (ophthalmia neonatorum), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe purulent discharge, and cases suspicious for gonococcal or chlamydial infection.
Viral Conjunctivitis
In-office rapid antigen testing is available for adenoviruses and has 89% sensitivity and up to 94% specificity. This test can identify the viral causes of conjunctivitis and prevent unnecessary antibiotic use.
Bacterial Conjunctivitis
Swabs for bacterial culture is generally reserved for cases of suspected infectious neonatal conjunctivitis (ophthalmia neonatorum), recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe purulent discharge, and cases suspicious for gonococcal or chlamydial infection.
Chlamydial Infection
Several laboratory procedures can be used to identify chlamydial infections. These include cell culture, direct fluorescent monoclonal antibody staining of smears, enzyme immuno-assays for Chlamydia organisms, DNA hybridization assays and a polymerase chain reaction test to identify chlamydial antigens Many ophthalmologists obtain conjunctival cytology scrapings for Gram's staining and/or Giemsa staining to help characterize the conjunctival inflammatory response. The findings can be helpful, particularly for diagnosing allergic, chlamydial and certain atypical forms of conjunctivitis in which the clinical diagnosis is not immediately apparent.
Gonococcal Infection
The diagnostic work-up for a gonococcal ocular infection includes immediate Gram staining of specimens for gram-negative intra-cellular diplococci, as well as special cultures for neisseria species.
Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.