Conjunctivitis is inflammation of the conjunctiva, usually caused by viruses, bacteria, or allergies. Symptoms are red eye with discharge; Allergic: Itching and watering; Viral: watering; Bacterial infections cause purulent drainage, and the eyelids are stuck together in the AM.
CASES/YEAR
4,170,000 (US); 83,400,000 (Global)
OTHER NAMES
Acute hemorrhagic conjunctivitis (AHC); Epidemic keratoconjunctivitis (EKC); Inclusion conjunctivitis; Neonatal conjunctivitis; Suppurative conjunctivitis;
INCUBATION
4-12 days for adenovirus infections; 12 hours to 3 days for picornavirus; 6-19 days for chlamydia, and 2-20 days for microsporidia; [CCDM, p. 129-34]
INITIAL SYMPTOMS
Red eye with discharge; Allergic: Itching and watering; Viral: watering; Bacterial infections cause purulent drainage, and the eyelids are stuck together in the AM. Tender preauricular nodes suggests gonorrhea/chlamydia. [ABX Guide]
PRECAUTIONS
Standard for bacterial; Contact for acute viral (acute hemorrhagic) for duration of illness. Adenovirus most common; Enterovirus 70 and Coxsackie virus A24 also associated with community outbreaks. Highly contagious; outbreaks in eye clinics, pediatric and neonatal settings, institutional settings reported. Eye clinics should follow Standard Precautions when handling patients with conjunctivitis. Routine use of infection control measures in the handling of instruments and equipment will prevent the occurrence of outbreaks in this and other settings. [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
> Allergic conjunctivitis is indistinguishable from viral conjunctivitis by exam. Adenovirus is the most common viral cause. HSV causes multiple vesicles of the eyelid. [ABX Guide]
> Allergic conjunctivitis is often accompanied by hay fever and allergic rhinitis. [Cecil, p. 2526]
> Preauricular lymphadenopathy is common in adenoviral and chlamydial conjunctivitis. {Cecil, p. 2527]
> Severe pain and skin lesions in the dermatome plus discharge, preauricular adenopathy, fever, and vomiting occur with herpes zoster ophthalmicus. [ABX Guide]
> Epidemic keratoconjunctivitis (EKC) and acute hemorrhagic conjunctivitis (AHC) are highly contagious and severe forms of viral conjunctivitis. [ABX Guide] EKC is caused by a few adenovirus serotypes. [Merck Manual, p. 941] AHC is caused by enteroviruses (EV-D70 and CV-A24). AHC has produced epidemics around the world with tens of millions of cases. It is transmitted directly by fingers and fomites and facilitated by crowded and unsanitary living conditions. It spreads rapidly from person to person at 24 hour intervals. Preauricular lymph nodes may be enlarged, and symptoms usually resolve within a week without permanent scarring or uveitis. EKC has a longer incubation (5-7 days) and persists for up to 2 or 3 weeks. [PPID, p. 2234-5]
> Symptoms of pharyngoconjunctival fever, caused by adenovirus infection, include fever, sore throat, and subsequent conjunctivitis. Preauricular adenopathy is present in 90% of cases. Spontaneous resolution is expected within 2 weeks. [PPID, p. 1500]
> Bacterial conjunctivitis: Purulent discharge (white, yellow, or green); Eyelids are stuck together upon awakening; Consider GC/Chlamydia if tender preauricular lymph nodes. [ABX Guide]
> Adult inclusion conjunctivitis is a sexually transmitted C. trachomatis infection. Patients have mucopurulent discharge, preauricular adenopathy, and follicular reaction. Men often have urethritis and women cervicitis. [PPID, p. 1503]
> Neonatal conjunctivitis (ophthalmia neonatorum) occurs in the first 4 weeks of life; it is usually caused by chemicals, Herpes simplex, C. trachomatis, gonococci, or other bacteria. [PPID, p. 1504-5]
> Actinomyces are a common cause of canaliculitis and chronic conjunctivitis. [Guerrant, p. 1001]
> Herpes simplex conjunctivitis is typically unilateral with symptoms of irritation and photophobia, but no discharge. Dendritic ulcers occur on the cornea and lid vesicles may be seen. [Cecil, p. 2526t]
> Herpes simplex can cause corneal scars. Gonococcal conjunctivitis can rapidly produce corneal ulcers --IM ceftriaxone for adults and hospitalize neonates for IV therapy. [5MCC-2020]
See "Brazilian purpuric fever." See "Varicella-zoster virus infection."
DIAGNOSTIC
Clinical; Culture and Gram stain for resistant, hyperpurulent, or recurrent cases; Use conjunctival smears to diagnose gonococcal disease (Gram stain) and chlamydia (DFA staining). [ABX Guide]
SIGNS & SYMPTOMS
-
>fever
-
E pharyngitis
-
O conjunctivitis, acute
-
O oculoglandular syndrome
-
*blindness
ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
TREATMENT
Discontinue contact lens during treatment of conjunctivitis. Disinfect or replace lens and discard lens case. Instruct patients with viral conjunctivitis about hand washing, not sharing personal items, and avoiding close personal contact for 2 weeks. [ABX Guide]
REFERENCES FOR CASES/YEAR
1. (US) 1/20 X global cases/yr;
2. (Global) 13.9 cases per 1000 reported in Netherlands general practice; [Gorbach, p. 136] Calculate: 13.9 x 6,000,000 = 83,400,000;