Conjunctivitis history and symptoms

The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable. Complete history will help determine whether the condition is associated with any specific environmental or work-related exposure.^[1][2]

A detailed and thorough history from the patient is necessary in order to determine the correct therapy.^[1]

Specific areas of focus when obtaining a history from the patient include:^[2][3]

• History of contact with the infected person’s eye drainage
• Recent upper respiratory infection (URI)
• Swimming in contaminated pools
• Contact lens use

Specific areas of focus when obtaining a history from the patient include:^[4][5]

• History of sexually transmitted disease (STD)
• History of exposure (contaminated fingers, oculogenital spread, and contaminated fomites)
• Contact lens use
• Chronic use of topical medications

Specific areas of focus when obtaining a history from the patient include:^[6][7][8]

• History of sexually transmitted disease (STD) in mother
• Ocular prophylaxis with silver nitrate

Specific areas of focus when obtaining a history from the patient include:^[9][10][11]

• Family history of atopic disease such as:
  • Allergic rhinitis
  • Bronchial asthma
  • Atopic dermatitis

Specific areas of focus when obtaining a history from the patient include:^[12][13]

• History of connective tissue disease
  • Sjögren’s syndrome
  • Rheumatoid arthritis
• History of thyroid abnormalities
• Contact lens use
• History of neurologic conditions (stroke, Bell’s palsy, Parkinson’s, trigeminal nerve problem)
• Prior eye surgery

Specific areas of focus when obtaining a history from the patient include:^[14][15]

• History of prolonged condition with gradual clearing
• History of thyroid abnormalities

The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable.

Adenovirus is the most common cause of viral conjunctivitis. It has acute or subacute onset, and often occurs in community epidemics. Both eyes may be affected simultaneously, or the second eye may become involved a few days after the first eye. Symptoms of viral conjunctivitis may include the following:^[2][3]

• Fever
• Sore throat
• Eye redness
• Watery discharge
• Eyelids swelling
• Swollen lymph node (ipsilateral)
• Itchy eyes
• Tearing
• Minimal eye pain
• Light sensitivity (with corneal involvement)

Acute hemorrhagic conjunctivitis (AHC) is a rapidly progressive. The infection starts ipsilaterally, but rapidly involves the fellow eye within 1 or 2 days. Symptoms of acute hemorrhagic conjunctivitis may include the following:^[16]

• Eyelids swelling
• Tearing
• Eye redness
• Severe eye pain
• Purulent discharge
• Subconjunctival hemorrhage

Bacterial conjunctivitis has hyperacute, acute, and chronic onset. Symptoms of bacterial conjunctivitis may include the following:^[4][5]

• Itchy eyes
• Tearing
• Eye redness
• Minimal eye pain
• Purulent discharge (grey or yellowish)
• Eyelids swelling

Hyperacute bacterial conjunctivitis (HBC) is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and rapid progression. Symptoms of hyperacute bacterial conjunctivitis may include the following:^[17]

• Eyelids swelling
• Tearing
• Diffuse eye redness
• Eye pain
• Decreased vision
• Severe purulent discharge (yellow-green)
• Swollen lymph nodes (preauricular)

Symptoms of neonatal conjunctivitis (ophthalmia neonatorum), based on causality, may include the following:^[6][7][8]

Gonococcal conjunctivitis is more severe than chlamydial conjunctivitis in newborns. The incubation period is 2-5 days. It is usually bilateral. Symptoms of gonococcal conjunctivitis may include the following:

• Severe purulent discharge (bilateral)
• Tearing
• Eyelids swelling

Chlamydial conjunctivitis has a later onset than gonococcal conjunctivitis in newborns. The incubation period is 5-14 days and the colonization of the eye after birth does not always result in infection. Symptoms of chlamydial conjunctivitis may include the following:

• Eye redness
• Watery or mild mucoid discharge
• Eyelids swelling

Chemical conjunctivitis usually occurs within 24 hours of instillation of silver nitrate solution and resolves spontaneously within a few days. Symptoms of chemical conjunctivitis may include the following:

• Eyelids swelling
• Eye redness
• Tearing

Symptoms of allergic conjunctivitis may include the following:^[9][18]

• Itchy eyes (most prominant)
• Tearing
• Eye redness (Bilateral)
• Watery discharge
• Light sensitivity (with corneal involvement)
• Foreign body sensation

Symptoms of keratoconjunctivitis sicca (dry eye syndrome) may include the following:^[12][13][19]

• Foreign-body sensation
• Grittiness
• Hyperemia
• Mucoid discharge
• Excessive tearing (secondary to reflex secretion)
• Light sensitivity
• Itchy eye
• Fluctuating blurry vision
• Malaise
• Weight loss

Symptoms of superior limbic keratoconjunctivitis (SLK) may include the following:ref name=”pmid11914237″>Watson S, Tullo AB, Carley F (2002). “Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens”. Br J Ophthalmol. 86 (4): 485–6. PMC 1771108. PMID 11914237.CS1 maint: Multiple names: authors list (link) </ref>^[15]

• Light sensitivity
• Excessive blinking
• Burning sensation
• Itchy eye
• Dry eye sensation

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