Conjunctivitis is inflammation of the conjunctiva. It can be classified as viral, bacterial, chronic, or noninfectious. Viral conjunctivitis is usually mild and self-limiting but highly contagious, while bacterial conjunctivitis requires antibiotic treatment. Hyperacute bacterial conjunctivitis demands prompt referral due to risk of sight loss. Treatment depends on etiology but generally involves relieving symptoms, with antibiotics used for bacterial cases.

1. CONJUNCTIVITIS

2. Defination
• Conjunctivitis: inflammation of the
conjunctiva
• Conjunctiva: thin, translucent, elastic tissue
layer with bulbar and palpebral portions
• Bulbar: lines the outer surface of the globe
to the limbus (junction of sclera and cornea)
• Palpebral: covers the inside of the eyelids

3. Classification of Conjunctivitis
Viral
• Infectious  Hyperacute
Bacterial  Acute
Chronic
• Noninfectious  Allergic, Toxins/
Chemicals, Foreign body, Trauma,
Neoplasm

4. Viral Conjunctivitis
• Most common viral cause is adenovirus
(enterovirus, HSV)
• Occurs in community epidemics (schools,
workplaces, physicians’ offices)
• Usual modes of transmission: contaminated
fingers, medical instruments, swimming pool
water

5. Viral Conjunctivitis
• Presentation: unilateral or
bilateral, acutely red eye,
watery or mucoserous
discharge, chemosis,
tender preauricular
node, burning/
sanding/gritty feeling in
eye(s), rarely photophobia
• May be part of viral
prodrome, fever,
pharyngitis, cough,
rhinorrhea

6. Acute Bacterial Conjunctivitis
• Common causes in neonates: Chlamydia
trachomatis, Neisseria gonorrhoeae
• In children: Haemophilus influenzae (80%),
Streptococcus pneumoniae (20%), and
Moraxella catarrhalis. Concurrent OM seen
in 25%.
• In adults: Staphylococcus aureus

7. Acute Bacterial Conjunctivitis
• Presentation: Unilateral or
bilateral, red eye,
mucopurulent or purulent
discharge continuously
throughout the day,
burning, irritation, mild
chemosis
• Neonates: symptoms
appear 5-14d after birth
(inclusion conjunctivitis
of the newborn)
• Highly contagious: spread
by direct contact or by
contaminated objects

8. Hyperacute Bacterial
Conjunctivitis
• Etiology: Neisseria species,
most commonly N. gonorrhoeae
• Presentation: profuse, purulent discharge with rapidly
progressive symptoms of marked conjunctival injection,
irritation, tenderness to palpation, chemosis, lid swelling,
and tender preauricular adenopathy
• Ophthalmia neonatorum: gonococcal ocular infection
with bilateral discharge 3-5d after birth from vaginal
transmission
• Sexually active teens: transmitted from genitalia to hands
to eyes, commonly see concurrent urethritis
• Sight-threatening

9. Chronic Bacterial Conjunctivitis
• Most common etiology: Staphylococcus species
• More common in adults and patients with acne
rosacea or facial seborrhea
• Presentation varies: redness, itching, burning,
foreign-body sensation, flaky debris, blepharitis
(common), eyelash loss
• Concurrently see styes and chalazia of the lid
margin from chronic inflammation of the
meibomian glands

10. Allergic Conjunctivitis
•
allergic rhinoconjunctivitis,
also called hay fever
rhinoconjunctivitis
• IgE mediated
hypersensitivity reaction
precipitated by small
airborne allergens local
mast cell degranulation
 release of chemical
mediators (histamine,
eosinophil chemotactic
factors, PAF, etc.)
Most commonly seasonal • Presentation: bilateral,
pruritis, redness,
watery discharge,
rhinorrhea/congestion
• Patients often have h/o
atopy, seasonal allergy
or specific allergy

11. Diagnosis ofConjunctivitis
• Clinical diagnosis of exclusion
• Morning crusting of eye
unreliable for determining
etiology
• If focal pathology (hordeolum, cancerous lesion or
blepharitis), conjunctivitis is reactive rather than
primary
• If redness is localized rather than diffuse, consider
foreign body, pterygium or episcleritis

12. “Pink Eye” Differential

13. Treatment
• Viral, allergic, and nonspecific
conjunctivitis are self-limited
• Bacterial conjunctivitis is also likely to be
self-limited but abx treatment shortens the
course, reduces person-to-person spread,
and lowers the risk of sight-threatening
complications

14. Treatment ofViral Conjunctivitis
• Topical antibiotics not necessary because
secondary bacterial infection is uncommon
• Reassurance that the sxs may get worse for 3-5d
before getting better and persist for 2-3 weeks
• Some relief from cold compresses and topical
antihistamines/decongestants
• Do not use topical corticosteroids due to risk of
sight-threatening complications (scarring, corneal
melting, perforation), especially if etiology is
herpes simplex virus or bacterial keratitis

15. Treatment ofAcute Bacterial
Conjunctivitis
• Topical broad-spectrum antibiotics: erythromycin
ointment, bacitracin-polymyxin B ointment (Polysporin),
trimethropim-polymyxin B (Polytrim), sulfa drops
Most H. flu and S. pneumoniae resistant to macrolides•
• Sulfa drops (Bleph-10): less effective and rare side effect
of Stevens-Johnson syndrome
• Rx: 1/2” ointment inside lower lid or 1-2 drops QID for 5-
7 days (response seen typically within 1-2d)
• Inclusion Conjunctivitis of the Newborn: treat with 2 week
course of erythromycin (50mg/kg/d po divided QID) or
sulfisoxazole (150mg/kg/d po divided QID), topical
unnecessary with systemic

16. Treatment of Hyperacute
Bacterial Conjunctivitis
Immediate ophthalmic referral
Systemic and topical antibiotics and saline irrigation
•
•
• Systemic antibiotic of choice due to penicillin-resistant N.
gonorrhoeae is single-dose Ceftriaxone (25-50mg/kg IV or
IM, not to exceed 125mg) or single-dose Cefotaxime
(100mg/kg IV or IM) in neonates
• If venereal disease present in teens, also treat with single-
dose of azithromycin (1g) because over 30% of these
patients will have concurrent chlamydial disease
• AAP and CDC recommendations for prevention of
ophthalmia neonatorum: silver nitrate 1% aqueous solution
(side effect of chemical conjunctivitis), erythromycin 0.5%
ophthalmic ointment, tetracycline 1% ophthalmic ointment

17. Treatment ofAllergic
Conjunctivitis
• Self-limited
• Allergen avoidance, cold compresses,
topical antihistamines/vasoconstrictors (do
not use for greater than 2 weeks), artificial
tears, topical NSAIDS (low efficacy)
• Prophylaxis: oral antihistamines (onset of
action=days), mast cell stabilizers (onset of
action=5-14d)

18. When to Referto
Ophthalmology
• Neonates
• Hyperacute Purulent Conjunctivitis
• Chronic Conjunctivitis
• Sxs of pain, blurred vision, and
photophobia
• Reactive conjunctivitis vs. primary