Conjunctivitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Physical examination of patients with conjunctivitis is usually remarkable for conjunctival injections, epiphora, hyperemia, chemosis, and muco-purulent or watery discharge. However, ophthalmologic examination may be varies based on conjunctivitis subtypes.^[1]^[2]

Physical Examination

Viral Conjunctivitis

Patients with viral conjunctivitis usually appear febrile, and they have preauricular adenopathy. Ophthalmologic examination of patients with viral conjunctivitis is usually remarkable for:^[1]^[2]

Epiphora
Hyperemia
Chemosis
Lymphoid follicle on the under-surface of the eyelid
Follicular conjunctival reaction
Pseudomembrane formation (occasionally)
Cicatricial conjunctival reaction
Eyelids ecchymosis
Corneal epithelial defect (in severe cases)

Acute Hemorrhagic Conjunctivitis

Ophthalmologic examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:^[3]

Eyelid edema
Eye pain in palpation
Bulbar conjunctival hemorrhage

Bacterial Conjunctivitis

Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:^[4]^[5]

Bulbar conjunctival injection
Palpebral conjunctival papillary reaction
Watery or mucopurulent discharge
Chemosis
Lid erythema
Corneal involvement (Neisseria gonorrhea)

Neonatal Conjunctivitis

Ophthalmologic examination of patients with neonatal conjunctivitis or ophthalmia neonatorum is usually remarkable for:^[6]^[7]^[8]

Neisseria gonorrhea
- Chemosis
- Severe lid edema
- Mucopurulent discharge
- Corneal involvement (diffuse epithelial edema, ulceration, corneal perforation, and endophthalmitis
Chlamydia trachomatis
- Mild hyperemia
- Mucoid discharge
- Chemosis
- Pseudomembrane formation
Chemical
- Mild conjunctival injection
- Epiphora

Allergic Conjunctivitis

Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:^[4]^[9]

Bilateral conjunctival injection
Chemosis
Watery discharge or mild mucous discharge
Large cobblestone papillae under upper eyelid

Keratoconjunctivitis Sicaa

Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, eyelashes, conjunctiva, cornea, and tear film. Examination of patients with keratoconjunctivitis sicaa is usually remarkable for:^[10]^[11]

Conjunctival redness
Damage to the ocular surface with punctate epithelial
Thickened eyelid margins and telangiectasia (signs of meibomian gland dysfunction)
Meibomian gland orifices are obstructed with a cloudy or granular secretion (expressed by exerting considerable pressure on the lower lid)
Blepharitis (associated with meibomian gland dysfunction)
Meibomitis (inflammation of the meibomian glands)

Superior Limbic Keratoconjunctivitis

Ophthalmologic examination of patients with superior limbic keratoconjunctivitis (SLK) is usually remarkable for:^[12]

Hyperemia
Micro-papillary reaction in the upper tarsal conjunctiva
Thickening of the superior bulbar conjunctiva
Ciliary injection in the upper bulbar conjunctiva
Corneal erosion in the upper quadrants
Diffuse superficial corneal erosions
Eyelid edema

References

↑ ^1.0 ^1.1 Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). “Adenoviral keratoconjunctivitis”. Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
↑ ^2.0 ^2.1 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.
↑ Yin-Murphy M (1976). “Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)”. Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
↑ ^4.0 ^4.1 Leibowitz HM (2000). “The red eye”. N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). “Sexually transmitted diseases treatment guidelines, 2010”. MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
↑ 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.
↑ Rours, Ingrid GIJG, et al. “Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants.” Pediatrics 121.2 (2008): e321-e326.
↑ Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.
↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). “Allergic conjunctivitis: a comprehensive review of the literature”. Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
↑ Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). “The pathology of dry eye: the interaction between the ocular surface and lacrimal glands”. Cornea. 17 (6): 584–9. PMID 9820935.
↑ Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). “Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies”. Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
↑ Nelson JD (1989). “Superior limbic keratoconjunctivitis (SLK)”. Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.

[pmid26077630-1] 1.0 ^1.1 Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). “Adenoviral keratoconjunctivitis”. Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.

[pmid24150468-2] 2.0 ^2.1 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.

[pmid1088513-3] Yin-Murphy M (1976). “Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)”. Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.

[pmid10922425-4] 4.0 ^4.1 Leibowitz HM (2000). “The red eye”. N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.

[pmid21160459-5] Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). “Sexually transmitted diseases treatment guidelines, 2010”. MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.

[pmid25606121-6] 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.

[ophthalmia-two-7] Rours, Ingrid GIJG, et al. “Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants.” Pediatrics 121.2 (2008): e321-e326.

[Ophthalmia-three-8] Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.

[pmid23497516-9] La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). “Allergic conjunctivitis: a comprehensive review of the literature”. Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.

[pmid9820935-10] Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). “The pathology of dry eye: the interaction between the ocular surface and lacrimal glands”. Cornea. 17 (6): 584–9. PMID 9820935.

[pmid19506195-11] Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). “Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies”. Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.

[pmid2695351-12] Nelson JD (1989). “Superior limbic keratoconjunctivitis (SLK)”. Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.

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