Conjunctivitis

Publication Date: February 12, 2024
Last Updated: February 16, 2024

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE 

Conjunctivitis rarely causes permanent visual loss or structural damage, but the economic impact of conjunctivitis is considerable and largely due to lost work or school time and the cost of medical visits, testing, and treatment. (, , )
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Chronic and/or recalcitrant conjunctivitis may be indicative of an underlying malignancy such as sebaceous carcinoma, lymphoma, or squamous cell carcinoma; or an underlying inflammatory condition, such as mucous membrane pemphigoid; or a chronic infection such as chlamydia. (, , )
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The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently, to use a separate towel and pillow, and to avoid close contact with others during the period of contagion, which is usually 10 to 14 days from onset. (, , )
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Tonometers that are inadequately disinfected can transmit infection. Dilute bleach soak (sodium hypochlorite) at 1:10 concentration is an effective disinfectant for tonometers. 70% isopropyl alcohol (e.g., alcohol wipes), 3% hydrogen peroxide, and ethyl alcohol are no longer recommended. Tonometers that utilize single-use disposable tips can circumvent the issue of sterilization. (, , )
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Indiscriminate use of topical antibiotics or corticosteroids should be avoided. Viral conjunctivitis will not respond to antibacterial agents, and mild bacterial conjunctivitis is likely to be self-limited. For acute exacerbations of vernal conjunctivitis, topical corticosteroids are usually necessary to control severe symptoms and sings. No evidence exists demonstrating the superiority of any topical antibiotic agent. (, , )
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Gonococcal conjunctivitis is a hyperacute, vision-threatening infectious condition that requires immediate systemic therapy. Single-use tubes of ophthalmic ointment containing 0.5% erythromycin are used as the standard prophylactic agent to prevent ophthalmia neonatorum. (, , )
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Conjunctivitis can be associated with systemic diseases. Diagnosis of superior limbic keratoconjunctivitis may lead to further investigations that reveal a thyroid disorder. Diagnosis of floppy eyelid syndrome should prompt a sleep study to rule out sleep apnea. (, , )
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Herpes zoster can cause conjunctivitis, keratitis, and ocular inflammation in multiple tissues of the eye. Herpes zoster vaccination is strongly recommended in patients 50 years or older and patients 19 years or older who are immunocompromised. (, , )
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Recommendation Grading

Overview

Title

Conjunctivitis

Authoring Organization

American Academy of Ophthalmology

Publication Month/Year

February 12, 2024

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Establish the diagnosis of conjunctivitis, differentiating it from other causes of red eye, Identify the cause(s) of conjunctivitis, istablish appropriate therapy, relieve discomfort and pain, prevent complications, prevent the spread of communicable diseases, educate and engage both the patient and the referring healthcare providers in conjunctivitis management

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, optometrist, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D003231 - Conjunctivitis, D003229 - Conjunctival Diseases, D003234 - Conjunctivitis, Bacterial, D003236 - Conjunctivitis, Viral

Keywords

conjunctivitis, opthalmology, red eyes

Source Citation

Cheung AY, Choi DS, Ahmad S, Amescua G, Jhanji V, Lin A, Mian SI, Rhee MK, Viriya ET, Mah FS, Varu DM; American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Panel. Cornea/External Disease Preferred Practice Pattern®. Ophthalmology. 2024 Feb 12:S0161-6420(24)00009-5. doi: 10.1016/j.ophtha.2023.12.037. Epub ahead of print. PMID: 38349304.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
280
Literature Search Start Date
March 1, 2017
Literature Search End Date
June 1, 2018