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Acute conjunctivitis: Overview, Clinical Evaluation

Publisher/Author : Pacific Cross

This post is also available in: Tiếng Việt (Vietnamese)

What is Acute conjunctivitis?

Acute conjunctivitis (adenoviral conjunctivitis or “pink eye”) is an inflammation that can be caused by infections from bacteria or viruses. Pink eye can also be caused by allergy, eye injury, or reaction to medication.

Acute conjunctivitis is highly contagious with intra-familial attack rates of up to 50% and 35-50% of patients develop complications.

Unlike bacterial conjunctivitis, which is usually self-limiting, acute conjunctivitis is associated with significant morbidity such as:

Decreased visual acuity or light sensitivity from persistent subepithelial infiltrates (inflammatory corneal deposits) Chronic epiphora (excessive tearing) from lacrimal drainage problems

Visual loss from conjunctival foreshortening and symblepharon (conjunctival scarring) formation

How common is Acute conjunctivitis?

Acute conjunctivitis is very common. Please discuss with your doctor for further information.


What are the symptoms of Acute conjunctivitis?

The common symptoms of Acute conjunctivitis are:

  • Eye redness
  • Swollen, red eyelids
  • Itching
  • Burning
  • Tearing
  • Eyelash matting or crusting
  • Foreign body sensation (feeling as if something is in the eye)

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes Acute conjunctivitis?

Acute conjunctivitis can be caused by numerous bacteria. Bacterial conjunctivitis is usually caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus sp, or, less commonly, Chlamydia trachomatis (see Trachoma). Neisseria gonorrhoeae causes gonococcal conjunctivitis, which usually results from sexual contact with a person who has a genital infection.

Ophthalmia neonatorum (neonatal conjunctivitis) results from a maternal gonococcal and/or chlamydial infection. Neonatal conjunctivitis occurs in 20 to 40% of neonates delivered through an infected birth canal.

Risk factors

What increases my risk for Acute conjunctivitis?

There are many risk factors for Acute conjunctivitis, such as:

  • Exposure to infected person
  • Infection in one eye
  • Environmental irritants
  • Allergen exposure
  • Camps, swimming pools, military bases
  • Asian or mediterranean young male
  • Atopy
  • Contact lens use
  • Ocular prosthesis
  • Mechanical irritation

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Acute conjunctivitis diagnosed?

  • Clinical evaluation
  • Sometimes culture of conjunctival smear or scrapings

Diagnosis of conjunctivitis and differentiation between bacterial, viral, and noninfectious conjunctivitis are usually clinical. Smears and bacterial cultures should be done in patients with severe symptoms, immunocompromise, ineffective initial therapy, or a vulnerable eye (eg, after a corneal transplant, in exophthalmos due to Graves disease). Smears and conjunctival scrapings should be examined microscopically and stained with Gram stain to identify bacteria and stained with Giemsa stain to identify the characteristic epithelial cell basophilic cytoplasmic inclusion bodies of chlamydial conjunctivitis.

How is Acute conjunctivitis treated?

  • Antibiotics (topical for all causes except gonococcal and chlamydial)
  • Bacterial conjunctivitis is very contagious, and standard infection control measures should be followed.

If neither gonococcal nor chlamydial infection is suspected, most clinicians treat presumptively with moxifloxacin 0.5% drops tid for 7 to 10 days or another fluoroquinolone or trimethoprim/polymyxin B qid.

A poor clinical response after 2 or 3 days indicates that the cause is resistant bacteria, a virus, or an allergy. Culture and sensitivity studies should then be done (if not done previously); results direct subsequent treatment.

Because of antimicrobial resistance and because chlamydial genital infection is often present in patients with gonorrhea, adult gonococcal conjunctivitis requires dual therapy with a single dose of ceftriaxone 1 g IM plus azithromycin 1 g po once (with azithromycin allergy or to treat expected chlamydial co-infection use doxycycline 100 mg po bid for 7 days).

Fluoroquinolones are no longer recommended because resistance is now widespread. Bacitracin 500 U/g or gentamicin 0.3% ophthalmic ointment instilled into the affected eye every 2 h may be used in addition to systemic treatment. Sex partners should also be treated. Patients need to be evaluated for other sexually transmitted diseases and the local public health authorities need to be notified.

Ophthalmia neonatorum is prevented by the routine use of silver nitrate eye drops or erythromycin ointment at birth. Infections that develop despite this treatment require systemic treatment.

For gonococcal infection, ceftriaxone 25 to 50 mg/kg IV or IM (not exceeding 125 mg) is given as a single dose. Chlamydial infection is treated with erythromycin 12.5 mg/kg po or IV qid for 14 days. The parents should also be treated.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Acute conjunctivitis?

The following lifestyles and home remedies might help you cope with Acute conjunctivitis:

  • Use hand sanitizer and/or wash their hands thoroughly after touching their eyes or nasal secretions
  • Avoid touching the noninfected eye after touching the infected eye
  • Avoid sharing towels or pillows
  • Avoid swimming in pools

If you have any questions, please consult with your doctor to better understand the best solution for you. Hello Health Group does not provide medical advice, diagnosis or treatment.

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