0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Conjunctivitis A Systematic Review of Diagnosis and Treatment

Amir A. Azari, MD1; Neal P. Barney, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318.
Text Size: A A A
Published online

Importance  Conjunctivitis is a common problem.

Objective  To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis.

Evidence Review  A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references.

Findings  Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors.

Conclusions and Relevance  The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Normal Conjunctival Anatomy

The conjunctiva is a thin membrane covering the sclera (bulbar conjunctiva, labeled with purple) and the inside of the eyelids (palpebral conjunctiva, labeled with blue).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Suggested Algorithm for Clinical Approach to Suspected Acute Conjunctivitis
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Characteristic Appearance of Bacterial and Viral Conjunctivitis

A, Bacterial conjunctivitis characterized by mucopurulent discharge and conjunctival hyperemia. B, Severe purulent discharge seen in hyperacute bacterial conjunctivitis secondary to gonorrhea. C, Intensely hyperemic response with thin, watery discharge characteristic of viral conjunctivitis. Images reproduced with permission: © 2013 American Academy of Ophthalmology.

Graphic Jump Location

Tables

References

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

24,693 Views
6 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
×
brightcove.createExperiences();