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.
• Despite lack of evidence, daycare regulations may require a child with presumed conjunctivitis to be treated with a topical antibiotic before returning (1)[A].

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