Definition
A.Inflammation of the conjunctiva, a thin transparent membrane that lines the inside of the eyelids and covers the sclera.
B.Commonly called pink eye.
Incidence
A.Allergic conjunctivitis.
1.Most common cause of conjunctivitis (15%–40% of population).
2.Most frequently occurs in spring and summer.
B.Viral conjunctivitis.
1.Most common cause of infectious conjunctivitis.
2.Most common type in adults.
3.More frequently occurs in the summer months.
C.Bacterial conjunctivitis.
1.Most common cause of infectious conjunctivitis in children.
2.Most frequently occurs in the winter and early spring months.
Pathogenesis
A.Allergic.
1.Not contagious.
2.Common in individuals with other signs of allergic disease.
3.Reaction to allergic triggers.
B.Infectious.
1.Bacterial.
a.Highly contagious.
b.Most common causative agents.
i.Staphylococcus aureus.
ii.Haemophilus influenzae.
iii.Streptococcus pneumoniae.
iv.Moraxella catarrhalis.
2.Viral.
a.Highly contagious.
b.Most common causative agent.
i.Adenoviruses.
ii.Rubella virus.
iii.Rubeola virus.
iv.Herpes viruses.
C.Noninfectious.
D.Other causes.
1.Environmental irritants.
2.Medications.
3.Toxins.
4.Chemicals.
Predisposing Factors
A.Exposure to allergens.
B.Exposure to environmental irritants.
C.Contact lens wearers.
D.Use of ophthalmic drops.
E.Old makeup products.
F.Occupational exposure to chemicals.
Subjective Data
A.Common complaints/symptoms.
1.Redness.
2.Discharge.
a.From the eye.
b.Crusts over the eyelid, especially after sleep.
3.Itching, burning.
4.Increased tearing.
5.Blurred vision.
6.Painless.
7.Feeling of foreign body in the eye.
B.Common/typical scenario.
1.Specific presentation varies dependent on type of conjunctivitis.
2.Symptoms of eye redness and discharge are common regardless of specific cause.
3.Contributing history and appearance of discharge often determines diagnosis.
C.Family and social history.
1.Review of symptoms.
a.Elicit the onset and duration of symptoms.
b.Determine if the patient or close contacts have any systemic illnesses.
c.Assess the patient for any risk factors.
d.Associated symptoms.
i.Rhinorrhea.
ii.Earache.
iii.Sore throat.
iv.Rash.
e.Single or both eyes.
2.Past medical history.
a.Recent illnesses.
b.Sick contacts.
c.Allergies.
d.Possible occupational exposure history.
e.Sexual history.
f.Contact lens use.
D.Review of systems.
1.Recent illnesses. Determine the onset and duration of symptoms.
a.Abrupt or gradual onset.
b.Determine if the patient or close contacts have any systemic illnesses.
2.Allergies.
3.Possible occupational exposure history.
4.Sexual history.
5.Pertinent systems review.
a.Head, ear, eyes, nose, and throat (HEENT).
i.Headache.
ii.Vision loss.
iii.Eye pain.
iv.Eye discharge.
v.Ear pain.
vi.Rhinorrhea.
vii.Nasal congestion.
viii.Cough.
b.Integumentary.
i.Rash.
ii.Lesions.
Physical Examination
A.Perform an eye examination, assessing for vision loss and eye discharge.
1.Appearance of eyes.
a.Allergic: Typically both eyes are infected.
b.Bacterial: Typically one eye is infected but may spread to other eye.
c.Viral: Typically both eyes are infected.
2.Discharge.
a.Allergic: Stringy.
b.Bacterial: Mucopurulent.
i.Copious yellow–green discharge is consistent with gonorrheal infection.
c.Viral: Watery.
3.Visual acuity.
4.Corneal opacity.
5.Pupil size and shape.
6.Eyelid swelling.
7.Presence of proptosis.
B.Red flags.
1.Reduction of visual acuity.
2.Ciliary flush.
3.Photophobia.
4.Severe foreign body sensation.
5.Corneal opacity.
6.Fixed pupil.
7.Severe headache with nausea.
8.Dendriform lesion indicative of herpes simplex virus (HSV).
Diagnostic Tests
A.Diagnosis is made with history and physical examination.
B.Imaging studies are not indicated unless underlying condition is suspected.
C.Culture should be considered.
1.In severe cases.
2.In patients who wear contact lenses.
3.In patient unresponsive to initial treatment.