Conjunctivitis

Background

• Number 1 cause of acute red eye

Diagnosis

• Rarely painful, more irritated
• Limbic sparing
• viral keratoconjucitivis assoc with URI and adeno
• watery viral/discharge bacterial/consider chlamydia

DDx

Viral Conjunctivitis

1. Treatment
   1. Artificial tears
   2. Cold compresses
   3. Consider topical antibiotics (e.g. erythromycin ophtho) if unable to differentiate from bacterial conjunctivitis
   4. Strict hand/general hygiene
   5. Follow up with ophtho if worsening or no improvement in 7 days

Bacterial Conjunctivitis

1. Purulent Discharge
2. adults: sulfacetamide or gent; cipro if pseudomonas; drops 10D OU

Allergic Conjunctivitis

1. Diagnosis
   1. Itching, watery eyes, rhinnorrhea
2. Treatment
   1. Avoidance of triggers
   2. NSAIDs
   3. oral antihistamines (e.g loratidine)
   4. Consider histamine-blocking drops (e.g. olopatadine, pemirolast, or ketotifen)
   5. Outpt ophtho

Chemical (Contact) Conjunctivitis

1. Topical Meds or Cosmetics
   1. irrigate, naphazoline drops, outpt for tx failure

See Caustic Keratoconjunctivitis

Chlamydia Conjunctivitis

1. PO erythromycin x 14D; CTX for gonorrhea

HSV Conjunctivitis

• Conjunctivitis alone or involving cornea, eyelid, and skin
• higher rate in HIV patients
• usually unilateral

1. Diagnosis
   1. Has more pain, burning, and a foreign body sensation than normal conjunctivitis
2. Treatment (all)
   1. Cool compresses
   2. Topical antiviral medication
      1. Trifluridine 1% drops, 5x per day x 10-14 dys, OR
      2. Vidarabine 3% ointment, 5x per day x 10-14 dys
3. Follow-up ophtho 2-5 days to monitor for corneal involvement

See Also

• Conjunctivitis (Peds)
• Eye Algorithm (Main)

Source

• Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin N Am. 2008;26:35-55.