Snapshot A 24-year-old man presents to his primary care phyisician for discomfort and redness in his eyes. He notes these symptoms began 2 days prior to presentation and is associated with a "sandy" or "gritty" sensation in his eyes. He also notes some discharge that makes his eyes difficult to open in the morning. A few days ago, he developed a cough with fever and pharyngitis that was managed with tea, analgesics, and antipyretics. On physical exam, there is bilateral conjunctival injection with watery discharge. There is no evidence of pus. (Acute viral conjunctivitis) Introduction Overview inflammation of the conjunctiva Anatomy Conjunctiva transparent tissue that adheres to the anterior portion of the sclera and lines the eyelids divided into 2 sections bulbar conjunctiva covers the sclera tarsal conjunctiva covers the inner eyelids covers up to the limbus Conjunctivitis Type Etiology Pathophysiology Presentation Diagnosis Management Bacterial conjunctivitis Staphylococcus aureus most common in adults Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Neisseria gonorrhoeae associated with hyperacute bacterial conjunctivitis this is a sight-treatening organism Direct contact with an infected substance Symptoms erythema pruritus the eye is "stuck shut" in the morning Physical exam purulent discharge the discharge is thick and globular found on the lid margins and corners of the eye Clinical diagnosis Medical and pharmacologic topical erythromycin ointment or trimethoprim-polymyxin B drops indication first-line treatment for bacterial conjunctivitis Hyperacute bacterial conjunctivitis Neisseria gonorrhoeae this is a sight-treatening organism Microorganism is transmitted from the genitalia to the hands and then to the eyes Symptoms erythema pruritus Physical exam profuse purulent discharge tenderness to palpation of the eye chemosis eyelid swelling periauricular adenopathy patients commonly have a concomitant urethritis Gram stain of the discharge demonstrating gram-negative diplococci Medical and pharmacologic topical and systemic antibiotics indication first-line treatment Viral conjunctivitis Adenovirus most common cause Direct contact with an infected substance Symptoms sandy, burning, or gritty sensation in the eye Physical exam watery or mucoserous discharge patients may have a concomitant upper respiratory tract infection Clinical diagnosis Conservative and lifestyles supportive management indication initial management viral conjunctivitis self-resolves Allergic conjunctivitis Allergen Airborne allergen interacts with IgE within the eye, leading to mast cell degranulation Symptoms erythema pruritus Physical exam watery or mucoserous discharge Clinical diagnosis Conservative and lifestyle allergen avoidance indication recommended in all types of allergic reactions Medical and pharmacologic eye drops indication first-line treatment medications mast cell stabilizers cromolyn antihistamines olopatadine alcaftadine dual-action medications pheniramine naphazoline Vernal conjunctivitis Allergic response that occurs in response to allergens or seasonally IgE and non-IgE mediated pathophysiology Physical exam papillae and pruritus in a seasonal pattern suggestive of vernal conjunctivitis Clinical diagnosis