Conjunctivitis causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [5], Sara Mehrsefat, M.D. [6]

Overview

Common causes of conjunctivitis include bacteria, viruses, and environmental factors.^[1] Viral conjunctivitis is the most common cause of infectious conjunctivitis both overall and in the adult population. Bacterial conjunctivitis is the second most common cause and is responsible for the majority of cases in children. Allergic conjunctivitis is the most frequent cause, affecting 15% to 40% of the population. Noninfectious conjunctivitis includes keratoconjunctivitis sicca (dry eye syndrome) and superior limbic keratoconjunctivitis may cause by inflammation secondary to immune-mediated diseases or mechanical irritation.^[2]

Causes

Viral conjunctivitis^[3]

Adenovirus (most common)
Herpes simplex virus (HSV) type 1 and 2
Varicella zoster virus
Picornaviruses (Coxsackievirus A24 and Enterovirus 70)
Molluscum contagiosum
Rubella virus
Epstein-Barr virus (EBV)

Bacterial conjunctivitis^[4]

Gram-positive bacteria
- Staphylococcus aureus
- Methicillin-resistant Staphylococcus aureus (common in nursing homes)
- Streptococcus pneumoniae
Gram-negative bacteria
- Pseudomonas aeruginosa
- Serratia marcescens
- Haemophilus influenzae (most common pathogen in children)
- Moraxella catarrhalis
- Chlamydia trachomatis (sexually transmitted bacteria)
- Neisseria gonorrhoeae (sexually transmitted bacteria)

Neonatal conjunctivitis^[5]^[6]

Septic
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Herpes simplex virus
- Pseudomonas aeruginosa (non–sexually transmitted bacteria)
- Staphylococcus aureus (non–sexually transmitted bacteria)
Aseptic
- Chemical (silver nitrate solution)

Allergic conjunctivitis^[3]

Allergens (pollen, animal dander, dust mites, or molds)

Keratoconjunctivitis^[7]

Lacrimal gland dysfunction (Sjögren’s syndrome) with reduced tear production
Reflex hyposecretion
Mucin deficiency
Low blink rate
Mechanical trauma
Vitamin A deficiency
Autoimmune diseases
Unknown etiology

Irritative Conjunctivitis

Contact lenses
Lens solutions
Chlorine in a swimming pool
Smog
Cosmetics

Causes by Organ System

Cardiovascular	Kawasaki disease, plasminogen deficiency
Chemical / poisoning	Acetaldehyde, acetic acid, acetic anhydride, acetylcarbromal, ammonia, anisole, arsenic trioxide, arsenic, arsenicals, beryllium, boric acid, box jellyfish poisoning, calcium sulfate, caterpillar poisoning, chemical irritation, chlorine dioxide, chloroacetophenone, cobra poisoning, CS gas, diethylene glycol monobutyl ether, dimethylamine, ether, ethylene oxide, euphorbiaceae, green lynx spider poisoning, hydrogen sulfide, lewisite, mayapple poisoning, metaldehyde, methylene diisocyanate, osmium, phosgene oxime, propylene glycol dinitrate, sulfuric acid, sulfuryl fluoride, toluene diisocyanate, vanadium, xylene
Dermatologic	Acute febrile neutrophilic dermatosis, Behcet’s disease, cicatricial pemphigoid, dyskeratosis congenita, erythema multiformae, euphorbiaceae, Kawasaki disease, Kindler syndrome, lepidopterism, leprosy, ocular cicatricial pemphigoid, psoriatic arthritis, rosacea, Stevens-Johnson syndrome, Sweet’s syndrome, xeroderma pigmentosum
Drug Side Effect	Acetylcarbromal, apraclonidine, artemether and lumefantrin, brimonidine tartrate and timolol maleate, cetuximab, clomethiazole, cyclopentolate, cytarabine, cytosine arabinose syndrome , desmopressin, dexamethasone, dimercaprol, dipivefrin, dornase alfa, doxorubicin hydrochloride, epirubicin hydrochloride, erythromycin, etretinate, flurbiprofen, fluticasone (spray), fosaprepitant, furfural, gadopentetate, galsulfase, hydroquinone, latanoprost,meclofenamate, medrysone,melarsoprol, methocarbamol, metipranolol, morpholine, moxifloxacin ophthalmic, nitisinone, orache (atriplex), pemetrexed, penicillium, pentamidine isethionate, pyridoxine hydrochloride, quinone, rasagiline, rifampin, rifapentin, secukinumab, sertraline, silver nitrate drops, tetracycline, thallous chloride tl 201, tocilizumab, travoprost
Ear Nose Throat	Cogan syndrome, oral allergy syndrome
Endocrine	No underlying causes
Environmental	Aesculus pollen, alder, dust mite, environmental pollution,smog, smoke
Gastroenterologic	No underlying causes
Genetic	Crouzon syndrome, dyskeratosis congenita, familial cold urticaria, Job syndrome, Kindler syndrome, type II tyrosinemia, xeroderma pigmentosum, x-linked agammaglobulinaemia
Hematologic	Hemorrhage, plasminogen deficiency, x-linked agammaglobulinaemia
Iatrogenic	No underlying causes
Infectious Disease	Acanthamoeba, adenovirus, alternaria, aspergillus, aureobasidium, candida albicans, cat scratch disease, chikungunya fever, chlamydia, cladosporium, congenital chlamydia, congenital gonorrhea, coxsackie virus, Crimean-Congo hemorrhagic fever, enterovirus 70, epicoccum, fusarium, gonorrhea, haemophilus influenzae, hantavirus pulmonary syndrome, helminth infections, helminthosporium, herpes simplex, herpes virus 2, herpes zoster, human enterovirus A, Kikuchi disease, Koch-Weeks conjunctivitis, leprosy, leptospirosis, listeria monocytogenes, Lyme disease, measles, molluscum contagiosum, moraxella catarrhalis, mucor, neisseria gonorrhoeae, neisseria meningiditis, Newcastle disease, non-specific urethritis, omsk hemorrhagic fever, onchocerciasis, pasteurella multocida, pediculosis ciliaris, pfiesteria piscicida, picornavirus, pseudomonas aeruginosa, psittacosis, respiratory syncytial virus, rhizopus, rosacea, rubella, sabia virus, serratia, smut, staphylococcus aureus, streptococcus pneumoniae, the clap, toxic-shock syndrome, trachoma, tularemia, viral conjunctivitis
Musculoskeletal / Ortho	Burns, Crouzon Syndrome , polychondritis
Neurologic	7th cranial nerve disorder, facial nerve palsy
Nutritional / Metabolic	Type II tyrosinemia, pyridoxine deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	Conjunctival squamous cell carcinoma, gestational trophoblastic neoplasia
Opthalmologic	Allergic conjunctivitis, Angelucci’s syndrome, bacterial conjunctivitis, blepharitis, Cogan syndrome, conjunctival squamous cell carcinoma, contact lens, corneal abrasion, dacryocystitis, ectropion, entropion, epidemic keratoconjunctivitis, familial cold urticaria, follicular conjunctivitis, giant papillary conjunctivitis, keratoconjunctivitis sicca, lacrimal canaliculitis, ligneous conjunctivitis, ocular cicatricial pemphigoid, ocular rosacea, ophthalmia neonatorum, phlyctenular keratoconjunctivitis, Theodore’s superior limbic keratoconjunctivitis, trachoma, vernal conjunctivitis, vernal keratoconjunctivitis, viral conjunctivitis
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Granulomatosis with polyangiitis, hantavirus pulmonary syndrome, Wegener’s granulomatosis
Renal / Electrolyte	Wegener’s granulomatosis
Rheum / Immune / Allergy	Allergic conjunctivitis, allergy, Behcet disease, cicatricial pemphigoid, common variable immunodeficiency, familial cold urticaria, familial hibernian fever, granulomatosis with polyangiitis, hay fever, hypersensitivity to pollen, Job syndrome, mold allergy, ocular cicatricial pemphigoid, oral allergy syndrome, polychondritis, psoriatic arthritis, reactive arthritis, Reiter’s syndrome, relapsing polychondritis, severe combined immunodeficiency, sicca syndrome, Sjogren’s syndrome, TNF receptor associated periodic syndrome, Wegener’s granulomatosis, x-linked agammaglobulinaemia
Sexual	No underlying causes
Trauma	Blunt injury, burns, penetrating trauma, trauma
Urologic	Non-specific urethritis
Dental	Crouzon syndrome
Miscellaneous	American feverfew, ash juniper tree, ash tree, beech tree, bermuda grass, birch tree, box elder tree, canary grass, capeweed, cocklebur, cypress tree, daisy, dandelion, elm tree, foreign body, goosefoot, guayule, hemp, hickory tree, hornbeam tree, horse chestnut tree, johnson grass, kentucky bluegrass, maple tree, marshelder, monteroy pine tree, mountain cedar tree, mugwort tree, oak tree, olea tree, olive tree, orchard grass, pecan trees, pigweed, plane tree, pollen, poplar tree, ragweed, rapeseed oil, redtop grass, ryegrass, sunflower, tilia tree, timothy grass, tumble weed, velvet grass, wall pellitory, walnut tree, white cedar tree, willow tree

Causes in Alphabetical Order

References

↑ National Eye Institute (2015). [1] Accessed on June 23, 2016
↑ Azari AA, Barney NP (2013). “Conjunctivitis: a systematic review of diagnosis and treatment”. JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
↑ ^3.0 ^3.1 Centers for Disease Control and Prevention (2016). [2] Accessed on June 23, 2016 Invalid parameter “viral” in <ref> tag. The supported parameters are: dir, follow, group, name.
↑ name= Bacterial Conjunctivitis > Centers for Disease Control and Prevention (2015). [3] Accessed on June 23, 2016
↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). “Neonatal conjunctivitis – a review”. Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
↑ Woods, Charles R. “Gonococcal infections in neonates and young children.” Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.
↑ Barabino S, Dana MR (2007). “Dry eye syndromes”. Chem Immunol Allergy. 92: 176–84. doi:10.1159/000099268. PMID 17264493.

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[Conjunctivitis-1] National Eye Institute (2015). [1] Accessed on June 23, 2016

[pmid24150468-2] Azari AA, Barney NP (2013). “Conjunctivitis: a systematic review of diagnosis and treatment”. JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.

[Bacterial-3] 3.0 ^3.1 Centers for Disease Control and Prevention (2016). [2] Accessed on June 23, 2016 Invalid parameter “viral” in <ref> tag. The supported parameters are: dir, follow, group, name.

[4] = Bacterial Conjunctivitis > Centers for Disease Control and Prevention (2015). [3] Accessed on June 23, 2016

[pmid25606121-5] Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). “Neonatal conjunctivitis – a review”. Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.

[Conjun-One-6] Woods, Charles R. “Gonococcal infections in neonates and young children.” Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.

[pmid17264493-7] Barabino S, Dana MR (2007). “Dry eye syndromes”. Chem Immunol Allergy. 92: 176–84. doi:10.1159/000099268. PMID 17264493.

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