Acute

Conjunctivitis
Pink Eye or Red Eye
Anatomy
• The conjunctiva is a loose connective tissue that
covers the surface of the eyeball (bulbar conjunctiva)
and reflects back upon itself to form the inner layer of
the eyelid (palpebral conjunctiva).
• The accessory lacrimal glands (Krause and Wolfring),
along with goblet cells, are contained within the
conjunctiva and are responsible for keeping the eye
lubricated.
Definition
• Describes any inflammatory process that involves the
conjunctiva; however, to most patients, conjunctivitis
(often called pink eye) is a diagnosis in its own right.
Clinical symptoms
• Redness
• Discharge
• Irritation
• Photophobia (possibly)
Classification by cause
• Viral (summer)
• Bacterial (winter and spring)
• Fungal
• Parasitic
• Toxic
• Chlamydial
• Chemical
• Allergic
Prognosis
• Most causes of conjunctivitis are benign, with a self-
limited process.
• However, depending on the immune status of the
patient and the etiology, conjunctivitis can progress to
increasingly severe and sight-threatening infections
• The role of the emergency physician is to separate
those few conditions requiring more vigorous
treatment from the majority that can be handled
satisfactorily in the emergency department.
Clinical Evaluation
• Eyelids sticking together on waking
• Itching and burning
• Foreign body sensation
• Vision distortion (pus sliding)
• Photophobia (minimal)
• URI history (viral cause)
Eye examination in patients with ocular
complaints
• Visual acuity
• Fluorescein staining
• Slit-lamp examination
• Tonometry
Factors causes negative culture result
• Age 6 years or older
• No or watery discharge
• No glued eye in the morning
Bilateral vs Unilateral disease

Bilateral Unilateral
• Infectious or allergic • Toxic, chemical,
mechanical, or lacrimal
origin
• IOP, pupil size, and light
response (Normal)
Bacterial Conjunctivitis
• Characterized by acute onset, minimal pain,
occasional pruritus, and, sometimes, exposure history.
• Predisposing factors: keratitis sicca, trichiasis, chronic
blepharitis
• Most common pathogens (Staphylococcal and
streptococcal)
• Chemosis is common
• The conjunctival discharge is copious, thick, and
purulent.
Chlamydial Conjunctivitis
• Characterized by chronic onset, minimal pain,
occasional pruritus, and a history of STD.
• Exacerbation and remission
• Chemosis is rare
• Discharge is minimal (seropurulent)
Viral Conjunctivitis
• Characterized by acute or subacute onset, minimal
pain level, and often, exposure history.
• Pruritus is common
• Clear watery discharge
• Photophobia and foreign-body sensation
• Preauricular adenopathy+follicular conjunctival
change=EKC
• DDx (HSV and Chlamydia)
Allergic Conjunctivitis
• Characterized by acute or subacute onset, no pain,
and no exposure history.
• Pruritus is extremely common and hallmark
• Clear, watery discharge
• Preauricular adenopathy is absent
Marginal Ulcers
• Small white ulcers that appear on the cornea at the
limbus.
• May indicate an allergic reaction to staphylococcal
antigen.
• Can cause blepharitis
• Pain, photophobia, and a foreign-body sensation
Giant Papillary Conjunctivitis
• Occurs mainly in contact lense wearers
• Develop a syndrome of excessive pruritus, mucous
production, and increasing intolerance to contact use.
• Giant papilla on the upper palpebral (lid eversion)
• Increased deposition on the contact lens (affected
eye)
Management
• Supportive
• Artificial tear
• Antibiotics
• Topical corticosteroids
• Decongestants
• Mast cell stabilizers
• NSAIDs
Thank you for your attention