What Do You See? A Refresher on Diagnosing Conjunctivitis

Acute conjunctivitis—inflammation of the white part of the eye and inner eyelid—is a prevalent disease that affects up to 6 million Americans annually.^1,2 Also known as pinkeye, conjunctivitis can result from an infection by a virus or bacterium or from a noninfection, such as an allergic response. Although conjunctivitis can be caused by other diseases or disorders, these 3 etiologies—viral, bacterial, and allergic—are the most common forms.^1-3

Understanding how pinkeye presents in its many iterations can be helpful to generalists and pediatricians; especially since most people who seek diagnosis and/or treatment often go to their primary care provider rather than an eye specialist.²

The following information—meant to provide a quick primer on the signs and symptoms of the most common types of conjunctivitis—summarizes information from healthychildren.org (a website of the American Academy of Pediatrics [AAP]) as well as guidance from Ellen Mitchell, MD, assistant professor of ophthalmology at Children’s Hospital of Pittsburgh of UPMC.

Viral conjunctivitis is often bilateral (usually one eye becomes pink and swollen first and then the other follows suit), and it’s usually preceded by an upper respiratory infection. Associated discharge is clear and watery, and light sensitivity can occur. Viral pinkeye is contagious and easily spreads among family members and playmates. The contagion period lasts while symptoms are present. (Although, those infected with the adenovirus can be contagious for several weeks after symptoms appear.)¹ More severe cases can have associated membrane and subconjunctival petechia and hemorrhage.

Bacterial conjunctivitis is characterized by purulent green or yellow discharge that may dry overnight, causing the eye to “crust shut” by morning. Coloration can be red or pink, and children might complain that the eye(s) is painful or itchy. This type of conjunctivitis can appear in one or both eyes. It’s also associated with eyelid edema and chemosis. Patients are no longer considered to be contagious once there is no pus coming from the eye. Bacterial conjunctivitis is much less common than viral or allergic pink eye.¹

Allergic conjunctivitis generally occurs seasonally. Patients can have associated hay fever and asthma. Findings are often itching, redness, excessive tearing, eyelid swelling, chemosis, and mucoid discharge. This is not contagious.¹

Early detection can help differentiate conjunctivitis from other more serious, sight-threatening diseases that share clinical presentations. It can also help shorten the length of inflammation, in some cases, and minimize time spent away from school.^2,3

To prevent the spread of disease, the AAP and the American Academy of Ophthalmologists recommend frequent hand washing—especially before and after touching the eyes, nose, and mouth—and using separate towels.^1,3 In addition, close contact with others should be avoided and diligent sanitation of items that often come in contact with hands and faces (like cuddle blankets, toys, and doorknobs), should be followed.^1,3

When asked what’s the most important thing pediatricians should know about diagnosing or treating conjunctivitis, Mitchell says, “Less severe forms of viral conjunctivitis (what is seen most commonly) should not be treated with antibiotics—only cold compresses, artificial tears, and supportive care.”

She adds that a referral to an ophthalmologist is appropriate “for any viral conjunctivitis associated with herpes simplex viral lesions on the face, a severe viral conjunctivitis associated with hemorrhages and membranes, any bacterial conjunctivitis, and any allergic conjunctivitis that does not respond to oral and topical antihistamines and mast cell stabilizers.”

Published: August 10, 2016