Conjunctivitis: Difference between revisions

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{{Adult top}} [[conjunctivitis (peds)]]
==Background==
==Background==
*Most common cause of acute red eye
*Most common cause of [[acute red eye]]
*Viral infection is usual etiology
*Viral infection is usual etiology
*Injected conjunctiva w/ perilimbal sparing
 
{{Conjunctivitis DDX}}
 
==Clinical Features==
*Injected conjunctiva with peri-limbal sparing
*Rarely painful; more irritated
*Rarely painful; more irritated


===Types===
{{Conjunctivitis images}}
#[[Viral Conjunctivitis]]
#[[Bacterial Conjunctivitis]]
#[[Allergic Conjunctivitis]]
#[[Herpes Zoster Ophthalmicus]]
#[[HSV Conjunctivitis]]
#[[Gonorrheal Conjunctivitis]]
#[[Chlamydia Conjunctivitis]]
#[[Caustic Keratoconjunctivitis]]


==Differential Diagnosis==
==Differential Diagnosis==
{| class="wikitable sortable"
{{Unilateral red eye DDX}}
|+ Conjunctivitis
{{Bilateral Red Eyes}}
|-
 
! scope="col" | ''''''
==Evaluation==
! scope="col" | '''Bacterial'''
*Typically clinical
! scope="col" | '''Viral'''
{{Clinical diagnosis of conjunctivitis}}
! scope="col" | '''Allergic'''
 
==Management==
*Viral infections - most common cause of conjunctivitis, but difficult to differentiate viral from bacterial
*Some clinicians treat all presentations as bacterial conjunctivitis
*Treatment considerations:
**Ointments - soothing effect, but interfere with vision
**Drops - no interference with vision
 
===[[Antibiotics]] for Bacterial Causes===
*Treatment for bacterial organisms is targeted toward [[S. aureus]], [[S. pneumoniae]], [[H. influenzae]], [[Pseudomonas]], [[N. gonorrhea]], [[C. trachomatis]]
*Contact lens wearers should be given coverage for [[Pseudomonas]] with one of the [[fluoroquinolone]] drops.
**Contact lens wearers should be advised to not wear their contacts until asymptomatic
 
{{Bacterial Conjunctivitis Treatment}}
 
{{GC Conjunctivitis Treatment}}
 
===Contraindicated===
*Corticosteroids have no benefit and can cause sight threatening injuries, especially in HSV or fungal causes of red eye
*Eye patching thought to exacerbate the infection


|-
==Disposition==
| Bilateral||50%||25%||Mostly
*Outpatient treatment
|-
| Discharge||Mucopurulent||Clear, Watery||Cobblestoning, none
|-
| Redness||Yes||Yes||Yes
|-
| Pruritis||Rarely||Rarely||Yes
|}


==See Also==
==See Also==
*[[Neonatal conjunctivitis]]
*[[Conjunctivitis (Peds)]]
*[[Conjunctivitis (Peds)]]
*[[Eye Algorithm (Main)]]
*[[Eye Algorithms (Main)]]


==Source==
==References==
*Mahmood, Narang. Diagnosis & management of acute red eye. Emerg Med Clin N Am 2008;26
*Mahmood, Narang. Diagnosis & management of acute red eye. Emerg Med Clin N Am 2008;26
*Tintinalli


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:ID]]

Latest revision as of 19:24, 26 September 2020

This page is for adult patients. For pediatric patients, see: conjunctivitis (peds)

Background

  • Most common cause of acute red eye
  • Viral infection is usual etiology

Conjunctivitis Types

Clinical Features

  • Injected conjunctiva with peri-limbal sparing
  • Rarely painful; more irritated

Conjunctivitis Images

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Bilateral red eyes

Evaluation

  • Typically clinical

Clinical diagnosis of conjunctivitis

Conjunctivitis
Bacterial Viral Allergic
Bilateral 50% 25% Mostly
Discharge Mucopurulent Clear, Watery Cobblestoning, none
Redness Yes Yes Yes
Pruritis Rarely Rarely Yes
Additional Treatment: Antibiotics Treatment: Hygiene Seasonal

Management

  • Viral infections - most common cause of conjunctivitis, but difficult to differentiate viral from bacterial
  • Some clinicians treat all presentations as bacterial conjunctivitis
  • Treatment considerations:
    • Ointments - soothing effect, but interfere with vision
    • Drops - no interference with vision

Antibiotics for Bacterial Causes

Bacterial Conjunctivitis

  • Counsel patient/family on importance of hand hygiene/avoiding touching face to prevent spread!
  • Apply warm or cool compresses (for comfort and cleansing) every 4 hours, followed by instillation of ophthalmic antibiotic solutions

These options do not cover gonococcal or chlamydial infections

  • Polymyxin B/Trimethoprim (Polytrim) 2 drops every 6 hours for 7 days OR
  • Erythromycin applied to the conjunctiva q6hrs for 7 days OR
  • Levofloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Moxifloxacin 0.5% ophthalmic 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Gatifloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN 1 drop every 6 hours for 5 days OR
  • Azithromycin 1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 days
  • Chloramphenicol 0.5% ophthalmic solution 1 drop QID for 7 days

NB: levofloxacin is preferred for contact lens wearers for coverage of pseudomonas. Advise not to wear contacts for duration of treatment

Chlamydial

  • Doxycycline 100mg PO BID for 7 days OR
  • Azithromycin 1g (20mg/kg) PO one time dose
  • Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days or erythromycin PO 50 mg/kg/day in 4 divided doses for 14 days [1]
    • Disease manifests 5 days post-birth to 2 weeks (late onset)

Gonococcal

  • Due to increasing resistance, CDC recommends dual therapy with Ceftriaxone and Azithromycin (even if patient is negative for Chlamydia).
  • Ceftriaxone 250mg IM one dose PLUS
  • Azithromycin 1g PO one dose
  • Newborn Treatment:
    • Prophylaxis: Erythromycin ophthalmic 0.5% x1
    • Disease manifests 1st 5 days post delivery (early onset)
    • Treatment Ceftriaxone 25-50mg IV or IM, max 125mg or cefotaxime single dose of 100 mg/kg (preferred if the patient has hyperbilirubinemia)
    • Also requires evaluation for disseminated disease (meningitis, arthritis, etc.)

Contraindicated

  • Corticosteroids have no benefit and can cause sight threatening injuries, especially in HSV or fungal causes of red eye
  • Eye patching thought to exacerbate the infection

Disposition

  • Outpatient treatment

See Also

References

  • Mahmood, Narang. Diagnosis & management of acute red eye. Emerg Med Clin N Am 2008;26
  1. ↑ Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):e107-e115. doi: 10.1093/jpids/piy060. PMID: 30007329; PMCID: PMC6097578.
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