History
In classic presentations, patients complain of eyelids
sticking together on waking.
They may describe itching and burning or a gritty foreign body sensation. Pus floating across the eye may distort vision, though visual acuity is normal. Photophobia is minimal. Family members with similar complaints
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Bacterial
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Ocular surface disease (eg, keratitis sicca , trichiasis, chronic blepharitis) predisposes the patient to bacterial conjunctivitis.
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Staphylococcus and Streptococcus species are the most common pathogens.
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Viral conjunctivitis is characterized by acute or subacute onset, a minimal level of pain, and often with an exposure history.
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Itching is common. A clear, watery discharge is the norm.
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Occassionally, severe photophobia and foreign body sensation occurs, usually caused by adenovirus (epidemic keratoconjunctivitis), when associated with keratitis.
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Check for preauricular adenopathy and a follicular conjunctival change, particularly on the palpebral conjunctiva. If present, the likely diagnosis is EKC.
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Be aware that herpes simplex and chlamydia also cause follicular conjunctivitis and preauricular adenopathy.
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Chlamydial conjunctivitis is characterized by chronic onset, a minimal level of pain, occasional itch, and a history of STD.
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Allergic conjunctivitis is characterized by acute or subacute onset, no pain, and no exposure history.
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Itch is extremely common. Clear, watery discharge is typical with or without a moderate amount of mucous production.
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An aggressive form of allergic conjunctivitis is vernal conjunctivitis in children and atopic conjunctivitis in adults. Vernal disease is often associated with shield corneal ulcers. Perilimbal accumulation of eosinophils (Horner-Trantas dots) is typical of vernal disease. Vernal keratoconjunctivitis, usually affecting young boys, tends to be bilateral and occurs in warm weather. It is presumed to be a hypersensitivity to exogenous antigens and may be associated with or accompanied by keratoconus.
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Giant papillary conjunctivitis resembles vernal disease.
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It occurs mainly in contact lens wearers who develop a syndrome of excessive itch, mucous production, and increasing intolerance to contact use.
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The giant papillae are predominantly on the upper palpebral conjunctiva and can only be seen on lid eversion.
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