Conjunctivitis, inflammation of the conjunctiva, can be classified into viral, bacterial, and allergic types, each with distinct symptoms and causes. Viral conjunctivitis is highly contagious, commonly caused by adenoviruses, presenting with red eyes and watery discharge, while bacterial conjunctivitis often presents with purulent discharge and may require antibiotic treatment. Allergic conjunctivitis typically features itching and redness and is commonly associated with seasonal allergies, with management focused on allergen avoidance and symptomatic relief.

1. CONJUNCTIVITIS

2. Definition
 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
 Fornices: where bulbar meets palpebral.

5. Classification of Conjunctivitis
Viral
 Infectious Bacterial
 Noninfectious 
 Allergic, Toxins/ Chemicals, Foreign
body, Trauma,

6. Viral Conjunctivitis
 Acute inflammation of conjunctiva characterized
by watery discharge and red eye.
 Most common viral cause is adenovirus
(enterovirus, HSV), Picornavirus, chickenpox,
molluscum contagiosum, coronavirus.
 Occurs in community epidemics (schools,
workplaces, physicians’ offices)
 Usual modes of transmission: contaminated fingers,
medical instruments, swimming pool water

7. • Viral conjunctivitis is highly contagious, usually for 10-12
days from onset as long as the eyes are red.
• Patients should avoid touching their eyes, shaking hands,
and sharing towels, among other activities.
• Transmission may occur through accidental inoculation of
viral particles from the patient's hands or by contact with
infected upper respiratory droplets, fomites (clothing,
bedding), or contaminated swimming pools.
• The infection usually resolves spontaneously within 2-4
weeks.

9. Viral Conjunctivitis
 Presentation: unilateral or bilateral, acutely red
eye, watery or mucoserous discharge, chemosis,
tender preauricular node, follicles, burning/
sanding/gritty feeling in eye(s), rarely
photophobia
 May be part of: lymph adenopathy (refers
to lymph nodes which are abnormal in size,
number or consistency and for swollen or
enlarged lymph nodes). Patient may also have,
fever, pharyngitis, cough, rhinorrhea (runny nose)

10. Swollen Preauricular Node

11. Conjunctival
Chemosis
Follicles
Follicles are small, dome-shaped nodules without a prominent central
vessel.

12. Typical appearance of Viral Conjunctivitis

13. Complications
Complications include the following:
Punctate keratitis, bacterial superinfection, conjunctival scarring,
severe dry eye, corneal ulceration with persistent
keratoconjunctivitis, corneal scarring.

14. Complications
Superficial Punctate Keratitis

15. Molluscum contagiosum
 MC is common
infection of skin
 Poxvirus
 The viral particle are
released from eyelid
lesion into the tear
film that cause
follicular
conjunctivitis
 Clinical FEATURES

16. MANAGEMNT
 Shave excision
 Cryotherapy
 Cauterization

17. Treatment of Viral
Conjunctivitis
 Topical antibiotics necessary if secondary
bacterial infection occurs.
 Reassurance that the symptoms 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

18. Acute Bacterial Conjunctivitis
 Common causes in neonates (ophthalmia
neonatorum): Chlamydia trachomatis, Neisseria
gonorrhoeae
 In children: Haemophilus influenzae,
Streptococcus pneumoniae
 In adults: Staphylococcus aureus

19. Ophthalmia Neonatorum Bacterial Conjunctivitis in Children
Severe Bacterial
Conjunctivitis

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

21. Signs and Symptoms
 Follicles on the inflamed conjunctiva
 Discharge: More purulent than in viral conjunctivitis, with more
mattering (generally white or yellow mucous discharge [green in
some cases]) of the eyelid margins and greater associated
difficulty opening the eyelids following sleep; patients waking up
with their eyes “glued” shut.
 Enlarged preauricular lymph node: Unusual in bacterial
conjunctivitis but found in severe conjunctivitis caused by N
gonorrhoeae
 Eyelid edema: Often present in bacterial conjunctivitis, but mild
in most cases; severe eyelid edema in the presence of purulent
discharge raises the suspicion of N gonorrhoeae infection

22. Eyelid Oedema Follicles

23. 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 seen styes and chalazia of the lid
margin from chronic inflammation of the
meibomian glands.

24. Acne Rosacea Seborrhoea

25. Blepharitis, Stye & Chalazion

26. Membranous conjunctivitis
 Acute inflammation of the conjunctiva,
and membrane formation on the
conjunctiva.
 Cause: corynebacterium diphtheria.

27. Allergic Conjunctivitis
 Most commonly seasonal allergic rhinoconjunctivitis, also called hay
fever rhinoconjunctivitis.
 Presentation: bilateral, pruritis/ Itching), redness, watery discharge,
rhinorrhea/congestion
 Signs are: red eyes, papillae, papillary hypertrophy, cobble stone
appearance in severe cases, limbitis, tarantas dots, shield ulcer,
corneal opacity.
 Patients often have h/o atopy, seasonal allergy or specific allergy

28. Allergy
A damaging immune response by the body to a substance,
especially a particular food, pollen, fur, or dust, to which it
has become hypersensitive.

29. Allergic Conjunctivits

32. Limbal signs include thickening and opacification of the limbal
conjunctiva as well as gelatinous appearing and sometime confluent
limbal papillae. Peri-limbal Horner-Trantas dots are focal white
limbal dots consisting of degenerated epithelial cells and eosinophils

33. Discharge
Discharge Associated with Conjunctivitis
Etiology Serous Mucoid Mucopurulent Purulent
Viral
Chlamydial
Bacterial
Allergic
Toxic
+
-
-
+
+
-
+
-
+
+
-
+
+
-
+
-
-
+
-
-
+=Present; ­=absent.
Adapted with permission from Jackson WB. Differentiating conjunctivitis of diverse origins. Surv Ophthalmol
1993;38(Suppl):91-104

34. “Pink Eye” Differential

35. Cultures
 Not necessary for initial diagnosis and
therapy of acute conjunctivitis
 When to culture:
1. Neonates
2. Hyperacute purulent conjunctivitis
(immediate Gram staining)
3. Chronic or recurrent conjunctivitis

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

37. Treatment of Bacterial
Conjunctivitis
 Most bacterial conjunctivitis are self-limiting, although topical antibiotics are
recommended because they can shorten the duration of the disease and
prevent the spread of infection.
 Broad-spectrum antibiotics are generally used empirically as first-line therapy
for bacterial conjunctivitis. Topical as opposed to oral antibiotics is
recommended to deliver high levels of the drug directly to the site of
infection, exceeding what is normally achieved in body tissues by oral routes.
Therefore, the antibiotic spectrum of the individual drug is enhanced.
 For severe conjunctivitis marked by purulent discharge and eye
inflammation, cultures are needed to guide the choice of antibiotic. Fortified
antibiotics such as combination aminoglycosides and cephalosporins have a
similar efficacy profile to fluoroquinolones. Resistance to early-generation
fluoroquinolones, however, has been increasing. Oral antibiotics are
recommended for gonococcal and chlamydial infections.

38. Treatment of Allergic
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 (prevention): oral
antihistamines (onset of action=days),
mast cell stabilizers (onset of action=5-14d)