Infective Conjunctivitis

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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

See also: Infective Conjunctivitis written for patients

Conjunctivitis is an inflammation of the conjunctiva resulting in dilatation of the conjunctival blood vessels, causing the eye to appear red. Inflammation may be limited to the conjunctiva (primary conjunctivitis) or may occur secondary to diseases affecting other parts of the eye - eg, iritis. There are a number of causes of conjunctivitis outlined in the separate article Conjunctivitis where more detail is provided about other, less common types of conjunctivitis. See also separate articles Allergic Conjunctivitis and Ophthalmia Neonatorum.

If you think that this is a conjunctival problem that is not infective conjunctivitis, see separate article Conjunctival Problems where you will find out more about assessing the conjunctiva, together with details on:

  • Conjunctival trauma.
  • Degenerative conditions of the conjunctiva (pinguecula, pterygium, concretions, retention cysts).
  • Other inflammatory conditions (mucus fishing syndrome, ligneous conjunctivitis).
  • Blistering mucocutaneous diseases (cicatricial pemphigoid, Stevens-Johnson syndrome).
  • Conjunctival lesions (pigmented, squamous tumours and other tumours).

Bacterial conjunctivitis is usually a benign self-limiting illness.[1]However, it can sometimes be serious or signify a severe underlying systemic disease. Occasionally, significant ocular and systemic morbidity may result.

Viral conjunctivitis can be prolonged and, in some cases, have lasting consequences. Adenoviral infection is usually (but not always) mild and self-limited, whereas herpes viruses can cause significant associated keratitis and uveitis.[2]

  • Infective conjunctivitis is one of the most common ocular problems seen in the community.
  • In adults, bacterial conjunctivitis is less common than viral conjunctivitis.[3]It is most commonly caused by Staphylococcus spp., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.[2]
  • In children, bacterial conjunctivitis is more common than viral and is mainly caused by H. influenzae, S. pneumoniae and M. catarrhalis.

Differentiating bacterial, viral and allergic conjunctivitis

It is not always easy to determine whether simple, acute conjunctivitis is bacterial, viral or allergic. Ultimately, swabbing the eye provides the most accurate diagnostic answer but it is not practical to do this for every patient. However, in severe, resistant, atypical cases or in immunosuppressed patients, swabbing for culture and sensitivities is important.

A history of infectious conjunctivitis and of itch both made the probability of current bacterial involvement less likely.  The absence of itch and the absence of a positive history of infective conjunctivitis make a diagnosis of bacterial conjunctivitis is more probable.[3]This may be explained by assuming that viral conjunctivitis is more prevalent or has a stronger tendency to recur than bacterial conjunctivitis and that itch suggests an allergic cause.

When patients describe their eyes glued together in the morning, this doesn't necessarily mean that there is a purulent discharge. Viral and allergic conjunctivitis often result in lids that are matted shut in the morning. However, these patients actually have crusting of the lashes due to drying of tears and serous secretions, not the wet, sticky, mucopurulent matting characteristic of bacterial conjunctivitis.

Presentation 

Symptoms

  • Discomfort - burning or gritty but not sharp.
  • Pain is minimal; significant pain suggests a more serious diagnosis.
  • Vision is usually normal, although 'smearing', particularly on waking, is common.
  • Discharge tends to be thick rather than watery.
  • There may be mild photophobia. Significant photophobia suggests severe adenoviral conjunctivitis or corneal involvement.

History

  • Ask about contact lens wear: establish whether this could be (or lead to) a problem of the (vulnerable) cornea.
  • Time course: onset, duration - in chronic cases consider venereal disease in people at a sexually active age.
  • Use of over-the-counter medication: consider whether this could be a reaction to previously administered drops or ointment.
  • Social aspect: establish whether anybody else has had it (family, school, work). Determine whether there are concerns about working during the course of the illness.

Findings

  • 'Red eye' with uniform engorgement of all the conjunctival blood vessels.
  • Bacterial conjunctivitis may often be distinguished from other types of conjunctivitis by the presence of a yellow-white mucopurulent discharge.
  • Eyes may be difficult to open in the morning, glued together by discharge.
  • There is also usually a papillary reaction (small bumps on the palpebral conjunctiva, appearing like a fine velvety surface). The presence of follicles is more likely to indicate viral conjunctivitis.
  • Bacterial conjunctivitis is usually bilateral (but often sequential).
  • Check visual acuity - this should be normal, other than the mild and temporary blur secondary to the discharge which can be blinked or wiped away.

Simple bacterial conjunctivitis

  • Bacterial infection may be by commensals or exogenous bacteria. The common culprits include S. aureus, S. epidermidis, S. pneumoniae and, in children, H. influenzae. Bacterial conjunctivitis accounts for no more than 50% of cases of infective conjunctivitis and is more common in children than in adults.
  • Risk factors - infants and children: nasolacrimal duct obstruction, concomitant otitis media or pharyngitis, exposure to an affected individual.
    Adults: as above, lid malposition, severe tear deficiency, immunosuppression and trauma.[4]
  • Symptoms - unilateral, uncomfortable (gritty or burning) red eye with a yellow-white mucopurulent discharge. Lids are often stuck shut on waking. Occasionally mild photophobia.
  • Signs - crusted lids (± oedema), evidence of mucous strands/discharge, velvety appearance of conjunctiva with papillae and, occasionally, superficial punctate keratitis.
  • Management - discontinue contact lens wear, swab if there is a large quantity of discharge, advise careful two to three times daily lid hygiene. In adults, simple bacterial conjunctivitis is usually a self-limiting condition lasting 10-14 days: good lid hygiene is enough. However, if the decision is made to use antibiotics (see 'Use of antibiotics in bacterial conjunctivitis ', below), chloramphenicol (drug of choice) or fusidic acid are suitable choices. Fluoroquinolones are reserved for more serious infections that need to be seen in a specialist unit.[5, 6]
  • Review - invite the patient to return if there is no improvement over a week or so, as prolonged infections can be associated with complications such as otitis media (25% of children with H. influenzae conjunctivitis) and corneal involvement (particularly in contact lens wearers).

Gonococcal conjunctivitis

  • Conjunctivitis of hyperacute onset (12-24 hours) caused by the same Neisseria gonorrhoeae responsible for venereal genitourinary tract infections. This organism is able to invade intact corneal epithelium (so non-contact lens wearers are no less at risk).
  • Risk factors - contact with infected individuals, presence of other sexually transmitted diseases.
  • Suggestive symptoms - rapid onset of unilateral/bilateral hyperpurulent red eye.
  • Signs to look for - tender lid oedema, profuse discharge, keratitis (look for oedema, fluorescein uptake, decreased visual acuity and photophobia), preauricular lymphadenopathy. 
  • Management - discontinue contact lens wear, swab, refer on for further assessment. After swabbing, systemic treatment will be with cefotaxime (length depends on whether there is corneal involvement or not) ± topical antibiotics.
  • Additional notes - the patient should be assessed for evidence of other venereal disease and treated concurrently for chlamydial infection. They should be informed of the nature of this infection and sexual partners should also be traced and treated as appropriate.[4]

Chlamydial infection

  • Chlamydial inclusion conjunctivitis is caused by serotypes D to K of Chlamydia trachomatis. It is transmitted by autoinoculation or eye-to-eye spread. It is a sexually transmitted disease with an incubation period of 1 week and may be associated with urethritis or cervicitis. 
  • Risk factors - contact with infected individuals, presence of other sexually transmitted diseases.
  • Symptoms - chronic low-grade conjunctivitis (may persist for 3 to 12 months if left untreated) with a green stringy discharge in the morning.
  • Signs - inferior conjunctival follicles, superior corneal pannus (superficial corneal neovascular area), palpable preauricular lymph nodes.
  • Management - discontinue contact lens wear, topical treatment with tetracycline ointment (qds for 6 weeks) and systemic doxycycline (100 mg bd for 1-2 weeks) or azithromycin (1 g single dose) or erythromycin (500 mg qds for 1 week if tetracycline is contra-indicated). There is ongoing debate as to which antibiotic is most effective (alone or in combination) but doxycycline is a good starting drug if there are no contra-indications and, in small studies, it has been associated with 100% cure rate.[7]
  • Additional notes - trachoma is caused by serotypes A to C of C. trachomatis and arises in the context of poor sanitation. It is the third most common cause of blindness worldwide, causing severe conjunctival cicatricial changes and secondary corneal ulceration and scarring.[9]

Ophthalmia neonatorum

This describes any conjunctivitis within the first 28 days of life. It is more extensively described in the related separate article Ophthalmia Neonatorum. It may be chemically induced or arise as a result of infection through contamination from the maternal genital tract. Chlamydial infection is the most common cause with gonococcal infection accounting for only about 1%. All cases should be referred to ophthalmology.

Non-drug treatment of bacterial conjunctivitis

  • Advise patients to discontinue contact lens wear until 24-48 hours after resolution of symptoms.
  • Although current guidelines do not recommend staying away from school or work, it seems reasonable for those who are more likely to transmit the infection (eg, young children) to stay at home until the symptoms have subsided. Some establishments have specific rules about this.
  • Remind the patient of other precautions to reduce transmission of infection - eg, no towel or make-up sharing, and avoid rubbing the eyes.
  • Advise the patient to return if symptoms worsen or persist beyond 10 days.
  • All infants with infective conjunctivitis within the first 28 days of life should be referred to a specialist.

Use of antibiotics for bacterial conjunctivitis

There is clear consensus that antibiotics are overprescribed for infective conjunctivitis - £4.7 million is spent on the NHS to treat 80% of cases of infective conjunctivitis when it is estimated that no more than 50% of patients (probably much fewer) have bacterial infection.[1]The arguments for and against the use of topical antibiotics can be summarised as follows:

For
Against
  • A study compared immediate antibiotics, no antibiotics or delayed antibiotics (prescription to be collected from the surgery at parents' or patients' discretion after three days). Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics.[1]
  • This has been corroborated by a meta-analysis suggesting that clinical and microbiological remission are faster with antibiotics (although the authors report the benefits as marginal and highlight the self-limiting nature of the condition).[5]
  • Acute bacterial conjunctivitis is frequently a self-limiting condition.
  • Up to 10% of individuals experience side-effects from the antibiotics prescribed.
  • The risk of serious effects from untreated bacterial conjunctivitis is low.

There is often resistance by patients to careful, conservative management. It is worth outlining the above points and a management decision can be made based on these. One option is to consider a 'watch and wait' approach for 7 days and start then if there is no improvement of symptoms.[2]This has been shown to reduce medicalisation of the patient and antibiotic use overall.[1]If treatment is initiated, it should be continued until 48 hours after the redness has resolved.

Drops versus ointment

Generally, drops should be prescribed in preference to ointments when a patient is taking other eye drops. Ointments are messy and may smear, causing blurred vision that would be impractical for daytime use in many people. However, ointment maintains the concentration of antibacterial agent in the eye longer than drops and some people, such as the elderly with arthritic hands, find ointment easier to apply. Using drops by day and ointment by night is the ideal.

For more general information about ocular prescriptions, see separate article Eye Drugs - Prescribing and Administering.

Drugs used[2]

  • Chloramphenicol has a broad spectrum of activity and is the drug of choice for superficial eye infections. It is bacteriostatic, with a relatively broad spectrum of action against most Gram-positive and Gram-negative bacteria. It is best avoided in people who have experienced myelosuppression during previous exposure to chloramphenicol, in those who have a blood dyscrasia or who have a family history of blood dyscrasias and in patients who are concurrently with other myelotoxic drugs. Avoid, in pregnant or breast-feeding women, as its safety has not been established. It should be avoided for prolonged periods, since it may increase the likelihood of sensitisation and resistance.
  • Fusidic acid is useful for staphylococcal infections and is an alternative antibacterial agent to chloramphenicol. Consider this particularly in pregnant women, those with a personal or family history of blood dyscrasias, such as aplastic anaemia, and patients who are intolerant of chloramphenicol.
  • Aminoglycosides have an incomplete coverage of Streptococcus spp. and Staphylococcus spp. and so this rules them out as first-line therapy. A relatively higher incidence of toxicity to the corneal epithelium has been recorded with prolonged use of aminoglycosides.
  • Fluoroquinolones such as ciprofloxacin and ofloxacin are reserved for serious ocular infections to limit the development of bacterial resistance. The fluoroquinolones have poor coverage of Streptococcus spp. Ciprofloxacin eye drops are licensed for corneal ulcers; intensive application (especially in the first 2 days) is required throughout the day and night.
  • Gentamicin, ciprofloxacin, levofloxacin, ofloxacin, and polymyxin B are effective for infections caused by Pseudomonas aeruginosa (contact lens wearers are the particular risk group for pseudomonal infection).
  • Trachoma (due to chronic infection with C. trachomatis) can be treated with oral azithromycin.[9]
  • Serious complications are rare in simple adult bacterial conjunctivitis.
  • Corneal ulceration: healthy intact corneas are relatively resistant to infection. However, contact lens wearers may have compromised corneas due to hypoxia, foreign body tracts from debris trapped between lens and eye or staining from lens use. Damaged corneal epithelium provides a potential point of entry for micro-organisms.
  • Chronic bacterial conjunctivitis can occur with eyelid disease such as blepharitis and meibomian gland inflammation.
  • Some organisms cause corneal or systemic complications, or both. Otitis media may develop in 25% of children with H. influenzae conjunctivitis, and systemic meningitis may complicate primary meningococcal conjunctivitis in 18% of cases.
  • Pneumonia occurs in 10-20% of infants following chlamydial conjunctivitis and neonatal conjunctivitis can result in a severe localised infection of the eye and potentially serious systemic complications.
  • Conjunctivitis is usually a self-limiting disease that does not cause any serious harm and spontaneous remission should occur within 7 days of onset.
  • Chlamydial conjunctivitis in adults is a chronic condition lasting months.
  • A recent meta-analysis has shown clinical remission by days 2-5 in 64% of people receiving placebo.[5]

Adenoviral conjunctivitis

Adenoviral conjunctivitis accounts for 65-90% of viral conjunctivitis. This is a highly infectious condition (incubation: 3-29 days, infectious for a further 2 weeks) which can range from mild to severe. There are many serotypes of the causative adenovirus (which is more commonly a cause of respiratory infection).[4]All cause a follicular conjunctivitis, but there are two distinct types of presentation:[10]

  • Pharyngoconjunctival fever: this is the more common form and tends to be mild. It most frequently occurs in children and young adults in association with a respiratory infection, and is highly contagious, transmitted regularly by direct contact but also through eye drops, mascara bottles and even swimming pools. There are systemic symptoms of sore throat, fever and headache, but corneal involvement is very rare.
  • Epidemic keratoconjunctivitis: this refers to adenoviral infection involving the cornea. This condition is more severe with formation of subepithelial corneal infiltrates and pseudomembranes. Patients may have photophobia and reduced vision long after the conjunctivitis settles.

Symptoms
These range in severity but are as follows:

  • Burning or gritty foreign body sensation.
  • Morning crusting.
  • Symptoms which usually start or predominate in one eye at first, becoming bilateral after a few days.
  • History of upper respiratory tract infection or of close contact with someone with a red eye is common.

Signs of adenovirus conjunctivitis

  • Red, irritated conjunctiva (may be very marked).
  • Conjunctival injection with folliculitis, particularly on the inferior palpebral conjunctiva.
  • Pinpoint conjunctival haemorrhages are sometimes seen.
  • Eyelid redness and oedema.
  • Watery mucoid discharge.
  • Preauricular lymphadenopathy is a classical sign.
  • Corneal involvement is seen in epidemic keratoconjunctivitis but usually not in pharyngoconjunctival fever.

Risk factors[4]

  • Exposure to an infected individual.
  • Upper respiratory tract infection.
  • Recent ocular examination.

Management

  • Mainly symptomatic and supportive.
  • Cool compresses and artificial tears several times daily for comfort.
  • Patients need to discontinue contact lens wear until 24 hours after symptoms have fully resolved.
  • Avoid antibiotic or antiviral drops unless superinfection is suspected, as there are as yet no effective eye drops against adenovirus. 
  • Prevent spread with strict hygiene measures around towels, bedding, hand-washing. 
  • Seek specialised advice for epidemic keratoconjunctivitis: pseudomembranes need removal and steroid eye drops may be used to prevent scarring.

Advice to patients

  • Symptoms may last 4-6 weeks and may get worse before getting better.
  • Patients should return if symptoms are not beginning to improve by 1-2 weeks.
  • Individuals need not take time off work or school if they are not systemically unwell and young children need not be excluded from nursery unless there is an outbreak.[2]However, many establishments reasonably ask that young children be kept at home until the symptoms have cleared.

Herpes simplex virus (HSV) conjunctivitis[11]

  • HSV conjunctivitis is usually caused by infection with herpes simplex type 1 (HSV-1). This occurs equally in young/middle-aged males and females (in contrast with herpes zoster virus, which is more commonly found in the elderly).
  • Primary infection is often subclinical (94-99% of cases).[11]It normally occurs in childhood or adolescence. Primary infection otherwise typically causes a blepharoconjunctivitis in which lid vesicles and crusting are characteristic.
  • Ocular infection then occurs with reactivation of the virus (see 'Risk factors', directly below), which lies dormant in the trigeminal nerve. The condition usually lasts 2-3 weeks.
  • Reactivation classically causes epithelial keratitis (inflammation of the superficial surface of the cornea). The eye is red and staining causes a classical dendritic corneal ulcer. Patients complain of foreign body sensation, reduced vision, and light sensitivity. This is typical of around 80% of cases.
  • Reactivation of HSV may also lead to stromal keratitis. This localised inflammation of the corneal epithelial layer (the middle layer) leads to corneal oedema and can rarely cause necrosis. It is an immune response rather than a direct effect of the live virus.
  • HSV can also involve the globe of the eye as keratouveitis.
  • Neonatal infection is more commonly caused by HSV-2 and occurs during vaginal delivery.

Risk factors[4]

  • Primary HSV infection: exposure to an infected individual.
  • Secondary HSV infection: previous ocular HSV or cold sores, physical stress (acute viral or febrile illness, trauma, menstruation), psychological stress, environmental stress (eg, ultraviolet light, cold wind).

Symptoms

  • Unilateral pain.
  • Photophobia.
  • Burning.
  • Watering (indicates corneal involvement).
  • Foreign body sensation.
  • Conjunctivitis.
  • Vision may be blurred if there is corneal ulceration in the central visual axis.

Signs

  • It is unilateral in around 90% of cases.
  • Conjunctival injection (limbal injection - redness around the whole of the cornea).
  • Watery discharge.
  • Follicles.
  • Concurrent herpetic skin vesicles may be seen along the lid margin.
  • Palpable preauricular lymph nodes.
  • Dendritic ulcer on staining with fluorescein, although multiple small epithelial lesions are typically seen in primary infection.
  • Hazy cornea (suggests stromal keratitis).
  • Fixed irregular pupil (indicates iritis).

Investigations
In painful red eye conditions corneal staining is imperative to rule out HSV dendritic ulcers: if in doubt, refer to a specialised team to assess for keratitis, as this may lead to complications, including scarring, and severe complications, such as perforation and visual loss.[11]

Management

  • Urgently refer cases of ocular herpes simplex to ophthalmology.
  • Discontinue contact lens wear.
  • Where there is corneal involvement (or if there has been corneal involvement in previous episodes), topical antiviral treatment, such as aciclovir, is the norm.
  • If the keratitis extends deep into the stroma, topical steroids may be used under specialised supervision to prevent scarring.
  • Some patients with recurrent HSV keratitis are kept on long-term prophylactic oral antivirals.[12]

Prognosis[2, 11]

  • Eyelid and conjunctival lesions tend to resolve over 1-2 weeks.
  • Epithelial keratitis also resolves over 2 weeks and has a good prognosis.
  • Stromal keratitis is more likely to result in corneal scarring.
  • Recurrence is common, particularly in the case of stromal keratitis.

Herpes zoster ophthalmicus[10]

This condition is caused by reactivation of dormant varicella-zoster virus which gives rise to shingles of the innervated dermatome. In 15% of cases of shingles, the eye is affected, so giving rise to herpes zoster ophthalmicus. Unlike herpes simplex eye infection, it is more common in elderly patients.

Risk factors

  • Physical trauma (including surgery).
  • Immunosuppression.
  • Greater age.

Symptoms

  • Prodromal symptoms: influenza-like illness with fatigue, malaise and low-grade fever lasting up to one week.[13]
  • Pre-herpetic neuralgia: various degrees of pain in the distribution of the ophthalmic nerve.
  • Erythematous macules progressing to vesicular rash affecting the forehead. 
  • Lesions progress to pustules then to crusting, eventually healing over several weeks.
  • Conjunctival injection and watering.
  • Immunocompromised patients have a much higher risk of developing herpes zoster ophthalmicus.[13]

Signs

  • Pain and rash confined to one dermatome.
  • Periorbital vesicular rash.
  • Note whether the tip of the nose is affected: if it is, there is significant risk of ocular complications (Hutchinson's sign - see separate article Corneal Problems - Acute and Non-acute).

Management

  • Start systemic antivirals as soon as you make the diagnosis (eg, aciclovir, valaciclovir or famciclovir).[13]
  • Refer for ophthalmic review. The eye and surrounding structures may also be affected and slit-lamp examination is needed to exclude corneal involvement or developing uveitis, scleritis, retinitis, neuritis and cranial nerve palsies. Possible sequelae include scarring and glaucoma.

Molluscum contagiosum conjunctivitis

This oncogenic virus generally infects the skin but occasionally spreads to mucous membranes (including the conjunctiva) of adolescents and young adults. It is commonly found in AIDS patients.

Risk factors[4]

  • Patients in an immunocompromised state.

Signs[14]

  • Unilateral/bilateral, single/multiple, dome-shaped umbilicated shiny nodules on the eyelid or lid margin.
  • Conjunctival follicles ± corneal pannus (conjunctiva creeping across the cornea).
  • It usually causes a chronic follicular conjunctivitis as a result of viral proteins spilling into the conjunctiva rather than due to primary infection of the conjunctiva itself. It can cause epithelial keratitis, pannus and scarring.

Management

  • Refer to ophthalmologists for excision, cryotherapy or cauterisation of lesions.
  • Resolution takes 3-12 months if untreated but early treatment by removal of the lesions reduces complications such as corneal scarring.

Unilateral conjunctivitis for more than a few days is unusual and should prompt a thorough assessment for the possibility of other, more serious, eye conditions.

Common problems

  • Viral conjunctivitis: a watery discharge is commonly seen with viral conjunctivitis.
  • Allergic conjunctivitis: suggested by moderate-to-severe itching, rhinitis or other hay fever symptoms and/or cobblestone elevations on the tarsal conjunctiva.
  • A foreign body may mimic conjunctivitis: everting the upper eyelid for examination, and staining with fluorescein is recommended if a foreign body is suspected.
  • Eye trauma: this may not always be remembered by the patient and can be mechanical or chemical.
  • Episcleritis: mild, acute-onset localised redness in one or both eyes.
  • Nasolacrimal blockage - this is very common in neonates and results in a sticky, discharging eye. The key thing is that the eye is not red and that the baby is otherwise well.
  • Blepharoconjunctivitis and meibomianitis: particularly seen in people with acne rosacea.
  • Dry eye syndrome.

Serious problems

Features suggesting serious eye conditions[2]
  • Moderate-to-severe eye pain or photophobia.
  • Marked redness in one eye.
  • Reduced visual acuity.
  • Acute glaucoma - look out for a reduced visual acuity, hazy cornea, fixed pupil and acute systemic malaise.
  • Uveitis - marked pain, photophobia and possibly decreased visual acuity should ring alarm bells in a 'conjunctivitis' not responding to conventional treatment, particularly in patients with previous episodes (they usually recognise their symptoms) or with systemic illnesses predisposing to uveitis.
  • Keratitis - often presents with a unilateral, acutely painful, photophobic, intensely injected eye. Acanthamoeba keratitis: may be seen in soft contact lens wearers with poor hygiene, prolonged wear, or swimming while wearing lenses.
  • Scleritis - usually presents with severe, boring ocular pain.
  • Orbital cellulitis - should be suspected if the person is unwell with red eye, blurred vision, headache, diplopia, eyelid oedema and erythema, restricted ocular motility and pain on movement. The sinuses are often but not always involved. Requires urgent admission.
  • Ocular herpes simplex - typically presents as a painful, red eye with dendritic ulcer seen on staining with fluorescein.
  • Herpes zoster ophthalmicus - establish whether there is any telltale rash (or severe herpetic pain which can occur before the rash). This may be associated with conjunctivitis.
  • Hyperacute conjunctivitis - severe sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection is characterised by a copious yellow-green purulent discharge that re-accumulates after being wiped away. The most common pathogens are N. gonorrhoeae and Neisseria meningitidis.

Further reading & references

  1. Everitt HA, Little PS, Smith PW; A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice. BMJ. 2006 Aug 12;333(7563):321. Epub 2006 Jul 17.
  2. Conjunctivitis - infective; NICE CKS, August 2012 (UK access only)
  3. Rietveld RP, ter Riet G, Bindels PJ, et al; Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. BMJ. 2004 Jul 24;329(7459):206-10. Epub 2004 Jun 16.
  4. Conjunctivitis Preferred Practice Pattern; American Academy of Ophthalmology, 2013
  5. Sheikh A, Hurwitz B.; Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD001211.
  6. Davis H, Mant D, Scott C, et al; Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. Br J Gen Pract. 2009 Dec;59(569):897-900. doi: 10.3399/bjgp09X473132.
  7. Low N; Chlamydia (uncomplicated, genital) BMJ Clin Evidence (online), last updated May 2006; Subscription required for full access to text
  8. Chlamydial Infections, Sexually Transmitted Disease Treatment Guidelines 2010; CDC Centers for Disease Control and Prevention
  9. Priority eye diseases, Trachoma; World Health Organization
  10. Denniston AKO, Murray PI; Oxford Handbook of Ophthalmology, Oxford University Press, 2009
  11. Herpes simplex - ocular; NICE CKS, September 2012 (UK access only)
  12. No authors listed; Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group. N Engl J Med. 1998 Jul 30;339(5):300-6.
  13. Evaluation and management of herpes zoster ophthalmicus; American Family Physician 2002: Nov 1:66 (9) 1723-1730
  14. Kanski J; Clinical Ophthalmology, A Systematic Approach, 5th Ed, Butterworth Heinemann (2003)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Colin Tidy
Current Version:
Peer Reviewer:
Dr Helen Huins
Document ID:
1841 (v25)
Last Checked:
11/02/2014
Next Review:
10/02/2019

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