Conjunctivitis, Acute

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Basics

Description

  • Inflammation of the bulbar and/or palpebral conjunctiva of <4 weeks’ duration
  • System(s) affected: nervous, skin/exocrine
  • Synonym(s): pink eye

Geriatric Considerations

  • Suspect bacterial, autoimmune, or irritative process.
  • If purulent, risk of bacterial cause increases with age and long-term care facility residence, with age >65 years and bilateral lid adherence. Risk for bacterial infection is >70%.

Pediatric Considerations

  • Neonatal conjunctivitis may be gonococcal, chlamydial, irritative, or related to dacryocystitis.
  • Pediatric ER study; 78% positive bacterial culture, mostly Haemophilus influenzae; 13% no growth; other studies showed >50% adenovirus.
  • Children <5 years of age 7× more likely have bacterial involvement than older patients.
  • Despite lack of evidence, daycare regulations may require a child with presumed conjunctivitis to be treated with a topical antibiotic before returning (1)[A].

Epidemiology

  • Predominant age
    • Pediatric: viral, bacterial
    • Adult: viral, bacterial, allergic
  • Predominant sex: male = female

Incidence
1–2% of ambulatory office visits, up to 3% of ER visits

Etiology and Pathophysiology

  • Viral
    • Adenovirus (common cold), coxsackievirus (implicated in recent hemorrhagic conjunctivitis epidemics in Asia and Middle East)
    • Enterovirus (acute hemorrhagic conjunctivitis)
    • Herpes simplex; herpes zoster or varicella
    • Measles, mumps, or influenza
    • COVID-19
  • Bacterial
    • Staphylococcus aureus, MRSA, or Staphylococcus epidermidis
    • Streptococcus pneumoniae
    • H. influenzae (children)
    • Pseudomonas spp. or anaerobes (contact lens users)
    • Acanthamoeba-contaminated contact lens solution (rare; ~30 cases/year in US).
    • Neisseria gonorrhoeae
    • Chlamydia trachomatis: gradual onset 1 to 4 weeks
  • Allergic
    • Hay fever, seasonal allergies, atopy
  • Nonspecific
    • Irritative: topical medications, wind, dry eye, UV light exposure, smoke, chlorine
    • Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis, Reiter syndrome, sarcoid
    • Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves disease, gout, carcinoid, psoriasis, Stevens-Johnson syndrome, molluscum contagiosum, rosacea, squamous neoplasia

Risk Factors

  • History of contact with infected persons
  • Sexually transmitted disease (STD) contact: gonococcal, chlamydial, syphilis, or herpes
  • Contact lenses: pseudomonal or acanthamoeba keratitis
  • Epidemic bacterial (streptococcal) conjunctivitis reported in school settings, epidemic adenoviral transmission in crowded settings

General Prevention

  • Wash hands frequently.
  • Eyedropper technique: while eye is closed and head back, several drops over nasal canthus and then open eyes to allow liquid to enter. Never touch tip of dropper to skin or eye.
  • Prevention of zoster (shingles) by vaccination is recommended in 50- to 70-year-old adults.

Commonly Associated Conditions

  • Viral infection (e.g., common cold)
  • Possible sexually transmitted infection

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Basics

Description

  • Inflammation of the bulbar and/or palpebral conjunctiva of <4 weeks’ duration
  • System(s) affected: nervous, skin/exocrine
  • Synonym(s): pink eye

Geriatric Considerations

  • Suspect bacterial, autoimmune, or irritative process.
  • If purulent, risk of bacterial cause increases with age and long-term care facility residence, with age >65 years and bilateral lid adherence. Risk for bacterial infection is >70%.

Pediatric Considerations

  • Neonatal conjunctivitis may be gonococcal, chlamydial, irritative, or related to dacryocystitis.
  • Pediatric ER study; 78% positive bacterial culture, mostly Haemophilus influenzae; 13% no growth; other studies showed >50% adenovirus.
  • Children <5 years of age 7× more likely have bacterial involvement than older patients.
  • Despite lack of evidence, daycare regulations may require a child with presumed conjunctivitis to be treated with a topical antibiotic before returning (1)[A].

Epidemiology

  • Predominant age
    • Pediatric: viral, bacterial
    • Adult: viral, bacterial, allergic
  • Predominant sex: male = female

Incidence
1–2% of ambulatory office visits, up to 3% of ER visits

Etiology and Pathophysiology

  • Viral
    • Adenovirus (common cold), coxsackievirus (implicated in recent hemorrhagic conjunctivitis epidemics in Asia and Middle East)
    • Enterovirus (acute hemorrhagic conjunctivitis)
    • Herpes simplex; herpes zoster or varicella
    • Measles, mumps, or influenza
    • COVID-19
  • Bacterial
    • Staphylococcus aureus, MRSA, or Staphylococcus epidermidis
    • Streptococcus pneumoniae
    • H. influenzae (children)
    • Pseudomonas spp. or anaerobes (contact lens users)
    • Acanthamoeba-contaminated contact lens solution (rare; ~30 cases/year in US).
    • Neisseria gonorrhoeae
    • Chlamydia trachomatis: gradual onset 1 to 4 weeks
  • Allergic
    • Hay fever, seasonal allergies, atopy
  • Nonspecific
    • Irritative: topical medications, wind, dry eye, UV light exposure, smoke, chlorine
    • Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis, Reiter syndrome, sarcoid
    • Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves disease, gout, carcinoid, psoriasis, Stevens-Johnson syndrome, molluscum contagiosum, rosacea, squamous neoplasia

Risk Factors

  • History of contact with infected persons
  • Sexually transmitted disease (STD) contact: gonococcal, chlamydial, syphilis, or herpes
  • Contact lenses: pseudomonal or acanthamoeba keratitis
  • Epidemic bacterial (streptococcal) conjunctivitis reported in school settings, epidemic adenoviral transmission in crowded settings

General Prevention

  • Wash hands frequently.
  • Eyedropper technique: while eye is closed and head back, several drops over nasal canthus and then open eyes to allow liquid to enter. Never touch tip of dropper to skin or eye.
  • Prevention of zoster (shingles) by vaccination is recommended in 50- to 70-year-old adults.

Commonly Associated Conditions

  • Viral infection (e.g., common cold)
  • Possible sexually transmitted infection

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