Conjunctivitis and its classification:
Conjunctiva:
Conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of
the eyelids. It has two parts, bulbar and palpebral. The bulbar portion begins at the edge of
the cornea and covers the visible part of the sclera; the palpebral part lines the inside of the
eyelids. Inflammation or infection of the conjunctiva is known as conjunctivitis1.
Conjunctivitis:
Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids
and covers the exposed surface of the sclera. It is the most common cause of “red eye.” The
aetiology can usually be determined by a careful history and an ocular examination, but
microbiological investigation may be necessary to establish the diagnosis or to guide
therapy2.
The prevalence of conjunctivitis varies according to the underlying cause, which may be
influenced by the patient’s age, as well as the season of the year. Viral conjunctivitis is
themost common cause of infectious conjunctivitis3. Bacterial conjunctivitis is the second
most common cause and is responsible for the majority of cases in children. Allergic
conjunctivitis is themost frequent cause, is observed more frequently in spring and summer.
Conjunctivitis can be divided into infectious and non-infectious causes. Viruses and
bacteriaare the most common infectious causes4.
Non-infectious conjunctivitis includes allergic, toxic and cicatricial conjunctivitis, as well as
inflammation secondary to immune-mediated diseases and neoplastic processes. The disease
can also be classified into acute, hyperacute, and chronic according to the mode of onset and
the severity of the clinical response5. Furthermore, it can be either primary or secondary to
systemic diseases such asgonorrhea, chlamydia, graft-vs-host disease, and Reiter syndrome,
in which case systemictreatment is warranted4.Neisseria infection should be suspected when
severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate
three to five days postpartum5. Conjunctivitis caused by Chlamydia trachomatis or Neisseria
gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is
usually self-limited6. For diagnosis and detection of conjunctivitis caused by Chlamydia
trachmatis, algorithm used for suspected viral conjunctivitis will be followed.
, Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis.
Treatment requires good eyelid hygiene and the application of topical antibiotics as
determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen
exposure. This condition is generally treated with topical antihistamines, mast-cell stabilizers
or anti-inflammatory agents7.
Patients with viral conjunctivitis typically present with an acute red eye, watery discharge,
conjunctival swelling, a tender preauricular node and in some cases, photophobia and a
foreign-body sensation8. Occasionally, patients also have subconjunctival hemorrhage. Both
eyes may be affected simultaneously, or the second eye may become involved a few days
after the first eye. Some patients have an associated upper respiratory tract infection9, 10.
It is important to differentiate conjunctivitis from other sight-threatening eye diseases
thathave similar clinical presentation and to make appropriate decisions about further testing,
treatment, or referral. An algorithmic approach may be helpful in diagnosis and treatment.
Figure 1: Suggested algorithm for classification of acute conjunctivitis:
Conjunctiva:
Conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of
the eyelids. It has two parts, bulbar and palpebral. The bulbar portion begins at the edge of
the cornea and covers the visible part of the sclera; the palpebral part lines the inside of the
eyelids. Inflammation or infection of the conjunctiva is known as conjunctivitis1.
Conjunctivitis:
Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids
and covers the exposed surface of the sclera. It is the most common cause of “red eye.” The
aetiology can usually be determined by a careful history and an ocular examination, but
microbiological investigation may be necessary to establish the diagnosis or to guide
therapy2.
The prevalence of conjunctivitis varies according to the underlying cause, which may be
influenced by the patient’s age, as well as the season of the year. Viral conjunctivitis is
themost common cause of infectious conjunctivitis3. Bacterial conjunctivitis is the second
most common cause and is responsible for the majority of cases in children. Allergic
conjunctivitis is themost frequent cause, is observed more frequently in spring and summer.
Conjunctivitis can be divided into infectious and non-infectious causes. Viruses and
bacteriaare the most common infectious causes4.
Non-infectious conjunctivitis includes allergic, toxic and cicatricial conjunctivitis, as well as
inflammation secondary to immune-mediated diseases and neoplastic processes. The disease
can also be classified into acute, hyperacute, and chronic according to the mode of onset and
the severity of the clinical response5. Furthermore, it can be either primary or secondary to
systemic diseases such asgonorrhea, chlamydia, graft-vs-host disease, and Reiter syndrome,
in which case systemictreatment is warranted4.Neisseria infection should be suspected when
severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate
three to five days postpartum5. Conjunctivitis caused by Chlamydia trachomatis or Neisseria
gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is
usually self-limited6. For diagnosis and detection of conjunctivitis caused by Chlamydia
trachmatis, algorithm used for suspected viral conjunctivitis will be followed.
, Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis.
Treatment requires good eyelid hygiene and the application of topical antibiotics as
determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen
exposure. This condition is generally treated with topical antihistamines, mast-cell stabilizers
or anti-inflammatory agents7.
Patients with viral conjunctivitis typically present with an acute red eye, watery discharge,
conjunctival swelling, a tender preauricular node and in some cases, photophobia and a
foreign-body sensation8. Occasionally, patients also have subconjunctival hemorrhage. Both
eyes may be affected simultaneously, or the second eye may become involved a few days
after the first eye. Some patients have an associated upper respiratory tract infection9, 10.
It is important to differentiate conjunctivitis from other sight-threatening eye diseases
thathave similar clinical presentation and to make appropriate decisions about further testing,
treatment, or referral. An algorithmic approach may be helpful in diagnosis and treatment.
Figure 1: Suggested algorithm for classification of acute conjunctivitis:
