Conjunctivitis, Acute
Conjunctivitis, Acute is a topic covered in the 5-Minute Clinical Consult.
To view the entire topic, please sign in or purchase a subscription.
5-Minute Clinical Consult (5MCC) app and website powered by Unbound Medicine helps you diagnose and manage 900+ medical conditions. Exclusive bonus features include Diagnosaurus DDx, 200 pediatrics topics, and medical news feeds. Explore these free sample topics:
-- The first section of this topic is shown below --
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 autoimmune, systemic, or irritative process.
- If purulent, risk of bacterial cause increases with age, 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 7 times more likely have bacterial involvement than older children or mid aged adults.
- 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
- Bacterial
- Staphylococcus aureus or Staphylococcus epidermidis
- Streptococcus pneumoniae
- H. influenzae (children)
- Pseudomonas spp. or anaerobes (contact lens users)
- Acanthamoeba-contaminated contact lens solution may cause keratitis (rare; ~30 cases per year in United States).
- Neisseria gonorrhoeae and Neisseria meningitidis
- Chlamydia trachomatis: gradual onset 1 to 4 weeks
- Escherichia coli neonatal conjunctivitis reported rarely, and tuberculosis reported in treatment resistant cases
- Allergic
- Hay fever, seasonal allergies, atopy
- Nonspecific
- Irritative: topical medications, wind, dry eye, UV light exposure, smoke
- Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis
- Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves disease, gout, carcinoid, sarcoid, psoriasis, Stevens-Johnson syndrome, Reiter syndrome
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
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.
Commonly Associated Conditions
- Viral infection (e.g., common cold)
- Possible sexually transmitted infection
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Citation
Stephens, Mark B., et al., editors. "Conjunctivitis, Acute." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute.
Conjunctivitis, Acute. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute. Accessed December 14, 2019.
Conjunctivitis, Acute. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute
Conjunctivitis, Acute [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 December 14]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Conjunctivitis, Acute
ID - 816752
ED - Stephens,Mark B,
ED - Golding,Jeremy,
ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute
PB - Wolters Kluwer
ET - 27
DB - 5minute
DP - Unbound Medicine
ER -