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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.
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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.

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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).

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Figure 2.
Suggested Algorithm for Clinical Approach to Suspected Acute Conjunctivitis
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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.

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