Physical Bacterial conjunctivitis
Preauricular adenopathy is occasional; chemosis (thickened, boggy conjunctiva) is common.
On any patient with ocular complaints, perform a complete physical exam of the eye, including visual acuity, fluorescein staining, slit lamp
exam, and tonometry. Specific helpful clues in differentiating the causes of conjunctivitis are listed below.
Viral conjunctivitis
-
Preauricular adenopathy is common in EKC and herpes; chemosis is variable.
-
Discharge amount is moderate, stringy or sparse; discharge quality is thin and seropurulent; conjunctival injection is moderate or marked.
Chlamydial conjunctivitis tends to be chronic with exacerbation and remission
-
Preauricular adenopathy is occasional; chemosis is rare;
-
Discharge amount is minimal; discharge quality is seropurulent; conjunctival injection is moderate.
Allergic conjunctivitis occurs with itching as the hallmark symptom.
-
Preauricular adenopathy is absent; chemosis is common.
-
Discharge amount is moderate, stringy or sparse; discharge quality is clear; conjunctival injection is moderate.
Marginal ulcers (small white ulcers that appear on the cornea at the limbus) may indicate an allergic reaction to staphylococcal antigen.
-
This is a toxin-related complication of Staphylococcus species that frequently causes blepharitis.
-
Pain, photophobia, and a foreign body sensation are common. The ulcers are sterile and respond to topical steroids.
Bilateral disease typically is infectious or allergic.
Unilateral disease suggests toxic, chemical, mechanical, or lacrimal origin.
-
Intraocular pressure is normal. Pupil size is normal. Light response is normal.
-
Ciliary flush, corneal staining, and anterior chamber reaction is absent unless is a significant amount of keratitis is associated as seen in EKC.