Conjunctivitis, Acute
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Basics
Description
- Inflammation of the bulbar and/or palpebral conjunctiva of <4 weeks’ duration
- System(s) affected: nervous, skin/exocrine
- Synonym(s): pink eye
Geriatric Considerations
- Suspect bacterial, autoimmune, or irritative process.
- If purulent, risk of bacterial cause increases with age and long-term care facility residence, with age >65 years and bilateral lid adherence. Risk for bacterial infection is >70%.
Pediatric Considerations
- Neonatal conjunctivitis may be gonococcal, chlamydial, irritative, or related to dacryocystitis.
- Pediatric ER study; 78% positive bacterial culture, mostly Haemophilus influenzae; 13% no growth; other studies showed >50% adenovirus.
- Children <5 years of age 7× more likely have bacterial involvement than older patients.
Epidemiology
- Predominant age
- Pediatric: viral, bacterial
- Adult: viral, bacterial, allergic
- Predominant sex: male = female
Incidence
1–2% of ambulatory office visits, up to 3% of ER visits
Etiology and Pathophysiology
- Viral
- Adenovirus (common cold), coxsackievirus (implicated in recent hemorrhagic conjunctivitis epidemics in Asia and Middle East)
- Enterovirus (acute hemorrhagic conjunctivitis)
- Herpes simplex; herpes zoster or varicella
- Measles, mumps, or influenza
- COVID-19
- Bacterial
- Staphylococcus aureus, MRSA, or Staphylococcus epidermidis
- Streptococcus pneumoniae
- H. influenzae (children)
- Pseudomonas spp. or anaerobes (contact lens users)
- Acanthamoeba-contaminated contact lens solution (rare; ~30 cases/year in US).
- Neisseria gonorrhoeae
- Chlamydia trachomatis: gradual onset 1 to 4 weeks
- Allergic
- Hay fever, seasonal allergies, atopy
- Nonspecific
- Irritative: topical medications, wind, dry eye, UV light exposure, smoke, chlorine
- Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis, Reiter syndrome, sarcoid
- Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves disease, gout, carcinoid, psoriasis, Stevens-Johnson syndrome, molluscum contagiosum, rosacea, squamous neoplasia
Risk Factors
- History of contact with infected persons
- Sexually transmitted disease (STD) contact: gonococcal, chlamydial, syphilis, or herpes
- Contact lenses: pseudomonal or acanthamoeba keratitis
- Epidemic bacterial (streptococcal) conjunctivitis reported in school settings, epidemic adenoviral transmission in crowded settings
General Prevention
- Wash hands frequently.
- Eyedropper technique: while eye is closed and head back, several drops over nasal canthus and then open eyes to allow liquid to enter. Never touch tip of dropper to skin or eye.
- Prevention of zoster (shingles) by vaccination is recommended in 50- to 70-year-old adults.
Commonly Associated Conditions
- Viral infection (e.g., common cold)
- Possible sexually transmitted infection
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Inflammation of the bulbar and/or palpebral conjunctiva of <4 weeks’ duration
- System(s) affected: nervous, skin/exocrine
- Synonym(s): pink eye
Geriatric Considerations
- Suspect bacterial, autoimmune, or irritative process.
- If purulent, risk of bacterial cause increases with age and long-term care facility residence, with age >65 years and bilateral lid adherence. Risk for bacterial infection is >70%.
Pediatric Considerations
- Neonatal conjunctivitis may be gonococcal, chlamydial, irritative, or related to dacryocystitis.
- Pediatric ER study; 78% positive bacterial culture, mostly Haemophilus influenzae; 13% no growth; other studies showed >50% adenovirus.
- Children <5 years of age 7× more likely have bacterial involvement than older patients.
Epidemiology
- Predominant age
- Pediatric: viral, bacterial
- Adult: viral, bacterial, allergic
- Predominant sex: male = female
Incidence
1–2% of ambulatory office visits, up to 3% of ER visits
Etiology and Pathophysiology
- Viral
- Adenovirus (common cold), coxsackievirus (implicated in recent hemorrhagic conjunctivitis epidemics in Asia and Middle East)
- Enterovirus (acute hemorrhagic conjunctivitis)
- Herpes simplex; herpes zoster or varicella
- Measles, mumps, or influenza
- COVID-19
- Bacterial
- Staphylococcus aureus, MRSA, or Staphylococcus epidermidis
- Streptococcus pneumoniae
- H. influenzae (children)
- Pseudomonas spp. or anaerobes (contact lens users)
- Acanthamoeba-contaminated contact lens solution (rare; ~30 cases/year in US).
- Neisseria gonorrhoeae
- Chlamydia trachomatis: gradual onset 1 to 4 weeks
- Allergic
- Hay fever, seasonal allergies, atopy
- Nonspecific
- Irritative: topical medications, wind, dry eye, UV light exposure, smoke, chlorine
- Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis, Reiter syndrome, sarcoid
- Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves disease, gout, carcinoid, psoriasis, Stevens-Johnson syndrome, molluscum contagiosum, rosacea, squamous neoplasia
Risk Factors
- History of contact with infected persons
- Sexually transmitted disease (STD) contact: gonococcal, chlamydial, syphilis, or herpes
- Contact lenses: pseudomonal or acanthamoeba keratitis
- Epidemic bacterial (streptococcal) conjunctivitis reported in school settings, epidemic adenoviral transmission in crowded settings
General Prevention
- Wash hands frequently.
- Eyedropper technique: while eye is closed and head back, several drops over nasal canthus and then open eyes to allow liquid to enter. Never touch tip of dropper to skin or eye.
- Prevention of zoster (shingles) by vaccination is recommended in 50- to 70-year-old adults.
Commonly Associated Conditions
- Viral infection (e.g., common cold)
- Possible sexually transmitted infection
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