Inflammation of eyelid and eyeball lining: Causes include infectious and non-infectious etiologies: see Table Table 1Clinical Presentations That May Distinguish in Acute Conjunctivitis for distinguishing features.
Discharge/Cells Seen on Scraping
Pre-auricular Lymph Node
Clear to mucoid, eosinophils
Moderate to severe
Mild to severe
Still used in some countries as systemic therapy. Cases of bone marrow aplasia and death have been reported with prolonged/frequent use.
Twice-daily dosing. Preferred for chlamydial conjunctivitis over oral erythromycin. May cause fetal harm. Short courses do not appear to stain teeth in pts < 8 years old. Photosensitivity in 10-15%
It treats many bacterial eye infections but may damage corneal epithelium with prolonged use. Use in treating specific gram negatives and S. aureus.
Eye drops are a big gun. Expensive. Alternative to ciprofloxacin. It would not use as the first line unless Pseudomonas is suspected, as in contact lens wearers. May achieve superior microbial eradication rates vs. ofloxacin. No crystalline precipitate.
Not as well absorbed as other fluoroquinolones. Risk of crystalluria. Patients receiving norfloxacin should be well-hydrated and instructed to drink fluids liberally. Otherwise similar to other quinolones.
Inconvenient four times a day alternative to doxycycline. May cause fetal harm. Stains teeth in pts < 8 years old. Photosensitivity.
May damage corneal epithelium. Alternative to gentamicin. Use in treating specific gram negatives and S. aureus.
Comment: AAP publication that includes a helpful chart with the ddx of neonatal conjunctivitis, testing recommendations and prophylaxis guidance.
Comment: This guideline from the CDC handles conjunctivitis GC, CT infection, including in neonatal populations. Recommendations include screening pregnant women at risk (e.g., women aged
< 25 years and those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, a sex partner who has an STI, or live in a community with high rates of gonorrhea) at first prenatal visit; retesting women in their third trimester at increased risk; and screening at delivery if not previously tested and at risk. Erythromycin is the only ophthalmic ointment recommended for use among neonates. Silver nitrate and tetracycline ophthalmic ointments are no longer manufactured in the United States. Testing for CT should be performed simultaneously along with GC in infants if at risk (hx GC, high risk mothers, lack of prenatal screening).
Comment: Highly detailed practice guideline directed toward ophthalmologists recommending molecular assays for CT and GC, if available. The document also includes descriptions of multiple subtypes of conjunctivitis of non-infectious nature with differential diagnoses and management.
Comment: This trial found that children with moxifloxacin drops had a shorter duration of symptoms. This also was similar to topical abx in general in the larger meta-analysis.
Comment: This monoclonal may cause bilateral conjunctivitis. Recommendations for management are included but are not solidly evidence-based.
Comment: The authors address the red-eye and provide helpful clinical distinguishing features to direct treatment. Of note, even bacterial conjunctivitis is usually self-limiting. Clinical data, though, is thin on most recommendations.
Comment: A prospective, multicenter clinical trial demonstrated that AdenoPlus is a rapid, sensitive and specific in-office test for detecting adenoviral conjunctivitis when compared to traditional tests (PCR and CC-IFA).
Comment: Though usually self-limiting, a review of 11 RCTs with 3673 patients finds some faster clinical improvement with topical antibacterials.
Comment: A review of topical azithromycin’s use in treating ocular infections, including conjunctivitis. Summarizes the available RCTs.
Comment: Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis characterized by sudden onset of painful, swollen, red eyes, w/ conjunctival hemorrhage and excessive tearing. The report summarizes the outbreak in Puerto Rico; 490K persons were affected; school-aged children and those living in crowded urban areas were at the highest risk. Prevention methods (e.g., frequent hand washing and avoidance of sharing towels and bedding) should be targeted at groups at the highest risk to control outbreaks.
Comment: A prospective, randomized-controlled, double-masked, multicenter study comparing the efficacy and safety of 0.5% levofloxacin ophthalmic solution with 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis. Although clinical cure rates in the 0.5% levofloxacin and 0.3% ofloxacin treatment groups were similar, a 5-day treatment regimen with 0.5% levofloxacin achieved microbial eradication rates that were statistically superior to those attained with 0.3% ofloxacin. There was no difference in the incidence of treatment-related adverse events.
Comment: Patients with adenoviral conjunctivitis need to dispose of unclean contact lenses as adenovirus survives chemical and hydrogen peroxide disinfection.
Comment: The in vitro antimicrobial susceptibilities of ocular isolates to levofloxacin, ofloxacin, and ciprofloxacin were determined. Levofloxacin demonstrated superior in vitro activity against human bacterial conjunctival isolates compared with either ofloxacin or ciprofloxacin (levofloxacin > ofloxacin > ciprofloxacin).
Comment: The predominant organism from the corneal scrapings of 11 contact lens wearers with bacterial keratitis was Pseudomonas aeruginosa.
Comment: In patients with allergic conjunctivitis, eye rubbing causes increased ocular itching, chemosis, and hyperemia.
Comment: Contact lens wearers are at risk for the development of bacterial keratitis. The bacteria most commonly isolated in this study were Serratia spp and Pseudomonas aeruginosa.
Comment: 12/26 patients with epidemic keratoconjunctivitis had positive adenovirus hand cultures.
Comment: A multicenter, double-masked, randomized trial was conducted, comparing 0.3% ofloxacin and 0.3% tobramycin for topical treatment of external ocular infection. Ofloxacin was found as effective, safe, and comfortable as tobramycin.
Comment: In a double-masked, randomized-controlled study, the effectiveness and safety of 0.3% ofloxacin solution were compared with those of 0.3% gentamicin ophthalmic solution in treating external bacterial ocular infections. The two treatments were found to be equally effective.
Comment: In two multicentered, randomized, prospective clinical studies, ciprofloxacin 0.3% ophthalmic solution was compared to a placebo and tobramycin 0.3%, respectively. In both trials, cipro was approximately 94% effective. Although cipro was significantly more effective than placebo, there was no difference in efficacy between ciprofloxacin and tobramycin.
Comment: This small study of 12 patients examined conjunctival GC. A single 1g IM injection of ceftriaxone in these 12 patients responded.
Comment: Johns Hopkins study examined the epidemiology of acute conjunctivitis in an inner city population. Out of 45 patients, viral conjunctivitis was diagnosed in 36%, bacterial in 40%, while 24% of cases remained undiagnosed.
Comment: 158 patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B, gentamicin sulfate or sodium sulfacetamide ophthalmic solution for 10 days. Clinical response at 3 to 6 days after the start of therapy was similar for all test agents. Clinical response at 2 to 7 days after completion of therapy was also similar, as was the bacteriologic response.
Comment: Review of 21 cases of gonococcal conjunctivitis between 1972 and 1986. Keratitis, anterior chamber inflammation, periocular edema and tenderness, gaze restriction and preauricular adenopathy were common findings. All patients were hospitalized and received parenteral antibiotics. Only 2/21 patients had a poor outcome.
Comment: A double-masked randomized study was conducted at four centers to compare the efficacy and safety of tobramycin and gentamicin ophthalmic ointment in treating superficial external eye disease. The results indicate that tobramycin is safe, effective and comparable to gentamicin. There was a trend towards better efficacy, safety and fewer adverse reactions in the tobramycin-treated group, but the differences were not statistically significant.
Comment: 84% of responders rated ketorolac as good to excellent in relieving their overall symptoms of ocular allergy and 86% felt that the drug produced good to excellent relief of their ocular itching within minutes to 1 hour of administration.
Comment: Trimethoprim-Polymyxin B is safe and well-tolerated for treating bacterial conjunctivitis in children. It is effective against both gram-positive and gram-negative organisms, including S pneumoniae and H influenzae, the most prevalent pathogens in pediatric patients.
Retracted lid shows inflammation of conjunctival lining causing inclusion bodies.
Source: CDC/S Lindsley