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    Conjunctivitis – Diagnosis and Treatment

    Ears, Eyes, Nose, and Throat, Infections

    Last Updated Jan 02, 2023
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    By Kevin Shi, Mark Kang


    • Conjunctivitis, aka “Pinkeye”, can affect people of all ages, and higher incidence in those who wear contact lenses, children, and those who are immuno-compromised.
    • It is an inflammation of the conjunctiva (the thin, clear tissue that lines the inside of the eyelid and that covers the white part of the eye).
    • Symptoms may include redness, itching, and discharge in the affected eye(s).
    • Can be caused by infections (bacterial or viral), allergies, or irritants.
    • Is often contagious, but usually a self-limited condition or easily treated.

    Diagnostic Process

    Common symptoms include:

    • Redness and swelling of the conjunctiva (the clear membrane that covers the white part of the eye and the inner surface of the eyelid).
    • Discharge from the eye, which may be clear, white, or yellowish.
    • Itching or burning sensation in the eye.
    • Increased tearing.
    • Sensitivity to light (photophobia).
    • Blurred vision.
    • Swelling of the eye or eyelid.
    • Crusting of the eyelashes, especially after sleep.
    • Swollen lymph nodes near the affected eye.
    • Pain or discomfort in the affected eye (in severe cases).

    Red flags to consider Ophthalmology consultation:

    • Photophobia.
    • Vision loss.
    • Pain with eye movement.
    • Poor response to ongoing treatment.
    • History of foreign body / trauma prior to presentation.

    This is primarily a clinical diagnosis and tests are not routine unless other diagnoses are suspected. To differentiate between the different etiologies, consider:


    • May be unilateral or bilateral.
    • May be accompanied by symptoms of a upper respiratory tract infection, such as nasal congestion or pharyngitis.
    • May cause watery discharge, sensation of grittiness, burning, and have crust on eyelid in the morning.
    • Often self-limiting and goes away on its own within a week or two.


    • Caused by bacteria, such as staphylococcus or streptococcus – consider Gonococcus.
    • Often starts in one eye, but can spread to the other eye.
    • May cause thick, yellow or green discharge.
    • May cause the eyelids to stick together, especially after sleep.


    • Often bilateral.
    • Caused by an allergic reaction to substances such as pollen, dust, or animal dander.
    • May cause itching, redness, grittiness and swelling of the conjunctiva.
    • May cause watery discharge and crust on eyelid in the morning.
    • May be accompanied by other allergic symptoms such as sneezing and a runny nose.

    Physical Exam

    • Examine the eye and eyelids for swelling, conjunctival injection, discharge.
    • Consider slit lamp exam +/- fluorescein for foreign bodies or trauma, signs of ulceration.
    • Consider visual acuity exam, pupils, confrontational visual fields, intraocular pressure with tonometer, extraocular movements.
    • Consider HEENT exam if suspicion for upper respiratory illness causing eye symptoms.

    Differential Diagnosis:

    • Dry eye syndrome.
    • Blepharitis.
    • Herpes Simplex Keratitis.
    • Uveitis.
    • Iritis.

    Recommended Treatment

    Treatment for conjunctivitis depends on the cause of the infection. The most common types of conjunctivitis are viral and bacterial, and they can often be treated with different approaches.


    • No specific treatment, self-limiting. Can recommend the following at home remedies for symptom management:
      • Apply a warm or cold compress to the affected eye several times a day.
      • OTC artificial tears/decongestant/antihistamine drops 1-2 drops 4 times daily PRN for up to 3 weeks.
      • Avoid wearing contact lenses until the infection has cleared up.
      • Wash your hands frequently to prevent the spread of the virus.


    • Most of the time self-limiting, and in mild cases can consider conservative management.
    • Antibiotic eye drops or ointment may shorten symptom duration.
    • For contact lens wearers, antibiotic topical treatment is needed.
    • Patients should respond to treatment in 1-2 days, and if persistent symptoms occur or representation to ED consider referral to ophthalmologist.
    • Those who play sports should refrain from returning to sport until 24 hours after treatment is started.
    • Options include:
      • Erythromycin 5mg/g ophthalmic ointment
        • 25cm four times daily for 5-7 days.
      • Polymyxin B/Trimethoprim 10000U/1mg/mL ophthalmic drops
        • 1-2 drops four times daily for 5-7 days.
      • Ciprofloxacin 0.3% ophthalmic drops (preferred in contact lens wearers)
        • 1-2 drops four times daily for 5-7 days.
      • Moxifloxacin 0.5% ophthalmic drops
        • 1 drop in the affected eye(s) 2 times daily for 7 days.


    • OTC artificial tears/decongestant/antihistamine/mast cell stabilizer drops 1-2 drops 4 times daily PRN for up to 4 weeks.
    • Avoiding the allergens that trigger the reaction.

    Quality Of Evidence?


    There have been extensive studies performed for diagnostic and treatment purposes in this field, that have been validated with no major limitations.


    Related Information

    Reference List

    1. American Academy of Ophthalmology Cornea/External Disease Panel: Preferred Practice Pattern Guidelines: Conjunctivitis. AAO website. Updated November 2018. Accessed December 06, 2022. https://www.aao.org/preferred-practice-pattern/conjunctivitis-ppp-2018

    2. Jacobs DS. Conjunctivitis. In: UpToDate. Waltham, MA. Accessed December 04, 2022. Available at: https://www.uptodate.com/contents/conjunctivitis?search=conjunctivitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

    3. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23;310(16):1721-9. doi: 10.1001/jama.2013.280318. Erratum in: JAMA. 2014 Jan 1;311(1):95. Dosage error in article text. PMID: 24150468; PMCID: PMC4049531.


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