Conjunctivitis is inflammation of the thin clear layer that covers the white of the eye and lines the eyelids, usually from a virus, bacteria or allergy. Most cases are mild and self-limited, and the main job is to rule out more serious causes of a red eye.
Key symptoms
- Red eye, one or both sides
- Watery discharge (viral) or thick yellow or green discharge (bacterial)
- Itching, the main symptom in allergic conjunctivitis
- Gritty or burning feeling, eyelids stuck together in the morning
- Vision is normal or clears with blinking
What you find on exam
- Visual acuity, which should be normal
- Diffuse redness of the conjunctiva, eyelid swelling
- Tender node in front of the ear in viral conjunctivitis
- Pupils normal and reactive, cornea clear
- Fluorescein stain to exclude a corneal ulcer or herpes dendrites
Tests
- Usually a clinical diagnosis, no tests needed
- Culture of the discharge if severe, in newborns or in contact lens wearers
- Gonorrhea and chlamydia testing if discharge is very heavy or in a newborn
Treatment basics
- Viral: cool compresses, artificial tears, hand washing; it lasts 1 to 3 weeks
- Bacterial: antibiotic drops such as polymyxin B with trimethoprim, or erythromycin ointment
- Contact lens wearers: stop lenses and use a fluoroquinolone drop that covers Pseudomonas
- Allergic: avoid triggers, antihistamine drops such as olopatadine or ketotifen
- Hyperacute gonococcal: same-day referral and ceftriaxone
Red flags
- Reduced vision, severe pain or sensitivity to light
- Corneal opacity or a fixed or irregular pupil
- Very heavy pus, or conjunctivitis in a newborn
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; CDC, Hand Hygiene in Healthcare Settings. Written by Making Synapses. Making Synapses is not affiliated with these organizations.