In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops. Bacterial
Bacterial conjunctivitis usually resolves without treatment. Topical antibiotics may be needed only if no improvement is observed after 3 days. No serious effects were noted either with or without treatment. Because antibiotics do speed healing in bacterial conjunctivitis, their use may be considered. Antibiotics are also recommended for those who wear contact lenses, are immunocompromised, have disease which is thought to be due to chlamydia or gonorrhea, have a fair bit of pain, or have copious discharge. Gonorrheal or chlamydial infections require both oral and topical antibiotics.The choice of antibiotic varies based on the strain or suspected strain of bacteria causing the infection. Fluoroquinolones, sodium sulfacetamide, or trimethoprim/polymyxin may be used, typically for 7–10 days. Cases of meningococcal conjunctivitis can also be treated with systemic penicillin, as long as the strain is sensitive to penicillin.When investigated as a treatment, povidone-iodine ophthalmic solution has also been observed to have some effectiveness against bacterial and chlamydial conjunctivitis, with a possible role suggested in locations where topical antibiotics are unavailable or costly. Chemical
Conjunctivitis due to chemicals is treated via irrigation with Ringers lactate or saline solution. Chemical injuries, particularly alkali burns, are medical emergencies, as they can lead to severe scarring and intraocular damage. People with chemically induced conjunctivitis should not touch their eyes to avoid spreading the chemical. Epidemiology
Conjunctivitis is the most common eye disease.
Reactive arthritis is highly associated with HLA-B27. Conjunctivitis is associated with the autoimmune disease relapsing polychondritis. Diagnosis
Cultures are not often taken or needed as most cases resolve either with time or typical antibiotics. If bacterial conjunctivitis is suspected, but no response to topical antibiotics is seen, swabs for bacterial culture should be taken and tested. Viral culture may be appropriate in epidemic case clusters.A patch test is used to identify the causative allergen in allergic conjunctivitis.Although conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy, and dysplasia, they are rarely done because of the cost and the general dearth of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected. Classification
Conjunctivitis may be classified either by cause or by extent of the inflamed area. Causes
Allergy
Bacteria
Viruses
Chemicals
AutoimmuneNeonatal conjunctivitis is often grouped separately from bacterial conjunctivitis because it is caused by different bacteria than the more common cases of bacterial conjunctivitis. By extent of involvement
Blepharoconjunctivitis is the dual combination of conjunctivitis with blepharitis (inflammation of the eyelids). Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation). Blepharokeratoconjunctivitis is the combination of conjunctivitis with blepharitis and keratitis. It is clinically defined by changes of the lid margin, meibomian gland dysfunction, redness of the eye, conjunctival chemosis and inflammation of the cornea. Differential diagnosis
Some more serious conditions can present with a red eye, such as infectious keratitis, angle-closure glaucoma, or iritis. These conditions require the urgent attention of an ophthalmologist.