Conjunctivitis

Background and Presentation 

  • Allergic, viral, or bacterial cause
  • All forms present with red and irritated conjunctiva
  • In practice it can be difficult to distinguish between the types of conjunctivitis.
    • Allergic: Hx of allergies/atopy, bilateral, chemosis, watery/mucoid discharge, itchiness predominant symptom
    • Viral: Hx of recent URI or exposure, unilateral first then bilateral, itchy/burning, subconjunctival hemorrhages or petechiae, watery/mucoid discharge, tender preauricular lymph nodes
    • Bacterial: Itching less prominent. Burning, aching, and stabbing discomfort predominates. Unilateral first then bilateral. Mucoid/purulent discharge (and more copious)
  • Blurry vision is common, but loss of vision should not occur if disease limited to conjunctiva

Management

  • Allergic: eliminate allergen, artificial tears, antihistamine/mast-cell stabilizer drops (olopatadine, ketotifen), oral antihistamine (diphenhydramine, loratadine)
  • Viral: 4-8x/day artificial tears, cold compresses, isolation precautions
  • Bacterial: culture/swab the ocular discharge, isolation precautions, moxifloxacin drops (Vigamox) QID or trimethoprim/polymyxin B drops/ointment for 5-7 days
  • Consult Ophthalmology if concern for worsening
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