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Infectious conjunctivitis is one of the most common causes of red eye. Infectious conjunctivitis is commonly caused
by bacterial or viral infection.
I. Pathophysiology
A. The clinical term "red eye" is applied to a variety of distinct infectious or inflammatory diseases of the eye.
Conjunctivitis is the most common cause of red eye. Conjunctivitis consists of inflammation of the conjunctiva,
which is caused by a broad group of conditions. The inflammation can be infectious or noninfectious in origin.
B. Most frequently, conjunctivitis is caused by a bacterial or viral infection. Sexually transmitted diseases such as
chlamydial infection and gonorrhea are less common causes of conjunctivitis. Ocular allergy is a major cause
of chronic conjunctivitis.
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2 Infectious Conjunctivitis
b. Blurred vision that fails to clear with a blink is not characteristic of conjunctivitis. This finding is indicative
of corneal or intraocular pathology.
E. Recent contact with an individual with an upper respiratory tract infection suggests adenoviral
conjunctivitis. Chlamydial or gonococcal infection may be suggested by the patient's sexual history, including
a history of urethral discharge. Use of topical medications (eg, vasoconstrictors or artificial tears), unusual
cosmetics and contact lenses should be sought because they may cause conjunctivitis.
III. Examination of the Eye
A. Visual acuity should be tested before the examination. Regional lymphadenopathy should be sought and the face
and eyelids should be examined. Viral or chlamydial inclusion conjunctivitis typically presents with a small,
tender, preauricular or submandibular lymph node. Palpable adenopathy is rare in acute bacterial conjunctivitis.
B. Herpes labialis or a dermatomal vesicular eruption is suggestive of shingles, indicative of a herpetic
conjunctivitis.
C. Purulent discharge suggests a bacterial infection, especially if the conjunctival injection is severe. Stringy mucoid
discharge suggests allergy. Clear watery discharge can be associated with a viral infection, particularly if
preauricular adenopathy is present.
Viral + - - -
Chlamydial - + + -
Bacterial - - + +
Allergic + + - -
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Infectious Conjunctivitis 3
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