Thanks to Michael Harmon for developing this awesome review of conjunctivitis for AMR, AND agreeing to let me put it up for all to see. That is kind of the point of this blog- share some of the great ambulatory teaching that is going on throughout the residency program with everyone.
If you want to be a guest poster too, it’s easy. Just shoot me an email and we’ll make it happen.

Images from visual DX.

Conjunctivitis

By Michael Harmon

Bacterial

• Bugs: Staph aureus is common in adults.  Strep pneumo, H. Influenza, and Moraxella catarrhalis are common in kids.  Think pseudomonas if a contact wearer
• Hyperacute bacterial conjunctivitis is usually secondary to N. gonorrhoeae.  Often have concomitant urethritis.  Requires hospitalization
•  Presentation: Usually unilateral conjunctival injection with thick discharge that reappears within minutes.  Eye matting is a non specific finding also seen in viral/allergic
• Treatment:  Usually self limited but treatment can decrease course.
  •  1^st line erythromycin ointment or polymyxin/trimethoprim gtts for 5-7 days
  • 2^nd line fluoroquinolones (contacts) or azithromycin
• Course: Should see improvement in 1-2 days  Send to optho if no improvement

Viral

• Bugs: adenovirus
• Presentation: conjunctivitis +/- viral prodrome (fever, URI symptoms).
  • Conjunctivitis is often bilateral.  Discharge is watery although may see some mucous on close exam.   Often complain of burning/gritty sensation in eyes.
  • Rapid (10 minute) test now available for adenovirus
• Treatment:  Self limited.  Treatment can help symptoms,  but won’t affect duration of symptoms.  Treat with OTC topical antihistamines/ decongestants
• Course: similar to that of common cold:  Symptoms may worsen in first few days and take several weeks to recover.

Allergic

• Presentation: Patients usually have history of seasonal /topical allergy or atopy
  • Exam similar to viral, although main complaint is usually itching
• Treatment:  May alleviate symptoms, doesn’t affect duration.  Treat with artificial tears and topical antihistamines.

Non-infectious, non-allergic

• Transient mechanical or chemical exposure
• Treatment:  Lubricant ointment/gtts
• Course: Usually resolves spontaneously within 24 hours

Red flags (when to refer)

• Decreased visual acuity
• Photophobia
• severe pain, severe HA/nausea
• severe sensation of foreign object that precludes opening eye
• corneal opacity
•  fixed pupil

Don’t give topical steroids because could cause corneal scarring, melting, perforation.  

Not due to topical steroids, but the best “corneal melting” picture I could find. This is due to advanced RA>