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Conjunctivitis, Acute

Conjunctivitis, Acute is a topic covered in the 5-Minute Clinical Consult.

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  • 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 autoimmune, systemic, or irritative conditions.
  • If purulent, risk of bacterial cause increases with age, the combo of age >65 years and bilateral lid adherence equates to risk for bacterial infection >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 were 7 times more likely to be bacterial than were older children or adults.
  • Daycare regulations sometimes require any child with presumed conjunctivitis to be treated with a topical antibiotic, despite lack of evidence (1)[A].


  • Predominant age
    • Pediatric: viral, bacterial
    • Adult: viral, bacterial, allergic
  • Predominant sex: male = female

In the United States accounts for 1–2% of ambulatory office 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
  • Bacterial
    • Staphylococcus aureus or Staphylococcus epidermidis
    • Streptococcus pneumoniae
    • H. influenzae (children)
    • Pseudomonas spp. or anaerobes (contact lens users)
    • Acanthamoeba-contaminated contact lens solution may cause keratitis (rare; ~30 cases/year in United States).
    • Neisseria gonorrhoeae and Neisseria meningitidis
    • Chlamydia trachomatis: gradual onset >4 weeks
  • Allergic
    • Hay fever, seasonal allergies, atopy
  • Nonspecific
    • Irritative: topical medications, wind, dry eye, UV light exposure, smoke
    • Autoimmune: Sjögren syndrome, pemphigoid, Wegener granulomatosis
    • Rare: Rickettsia, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, chikungunya, Graves, gout, carcinoid, sarcoid, psoriasis, Stevens-Johnson, Reiter syndrome

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

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.

Commonly Associated Conditions

  • Viral infection (e.g., common cold)
  • Possible STD

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Stephens, Mark B., et al., editors. "Conjunctivitis, Acute." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute.
Conjunctivitis, Acute. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute. Accessed April 18, 2019.
Conjunctivitis, Acute. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute
Conjunctivitis, Acute [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Conjunctivitis, Acute ID - 816752 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816752/all/Conjunctivitis__Acute PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -