Conjunctivitis

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Physical
On any patient with ocular complaints, perform a complete physical exam of the eye, including visual acuity, fluorescein staining, slit lamp

exam, and tonometry. Specific helpful clues in differentiating the causes of conjunctivitis are listed below.
  • Bacterial conjunctivitis

    • Preauricular adenopathy is occasional; chemosis (thickened, boggy conjunctiva) is common.

    • Discharge amount is copious; discharge quality is thick and purulent; conjunctival injection is moderate or marked.

  • Viral conjunctivitis

    • Preauricular adenopathy is common in EKC and herpes; chemosis is variable.

    • Discharge amount is moderate, stringy or sparse; discharge quality is thin and seropurulent; conjunctival injection is moderate or marked.

  • Chlamydial conjunctivitis tends to be chronic with exacerbation and remission

    • Preauricular adenopathy is occasional; chemosis is rare;

    • Discharge amount is minimal; discharge quality is seropurulent; conjunctival injection is moderate.

  • Allergic conjunctivitis occurs with itching as the hallmark symptom.

    • Preauricular adenopathy is absent; chemosis is common.

    • Discharge amount is moderate, stringy or sparse; discharge quality is clear; conjunctival injection is moderate.

  • Marginal ulcers (small white ulcers that appear on the cornea at the limbus) may indicate an allergic reaction to staphylococcal antigen.

    • This is a toxin-related complication of Staphylococcus species that frequently causes blepharitis.

    • Pain, photophobia, and a foreign body sensation are common. The ulcers are sterile and respond to topical steroids.

  • Bilateral disease typically is infectious or allergic.

  • Unilateral disease suggests toxic, chemical, mechanical, or lacrimal origin.

    • Intraocular pressure is normal. Pupil size is normal. Light response is normal.

    • Ciliary flush, corneal staining, and anterior chamber reaction is absent unless is a significant amount of keratitis is associated as seen in EKC.

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