Conjuctivitis in detail
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https://www.cdc.gov/conjunctivitis/hcp/clinical-overview/ind…
Conjunctivitis: topic map
- Definition and anatomy of the conjunctiva
- Causes: viral, bacterial, allergic, chlamydial, gonococcal, chemical/toxic, and neonatal
- Symptoms and signs: discharge, itching, redness, eyelid swelling, lymph nodes
- How to distinguish the main types
- Diagnosis and differential diagnosis of a red eye
- Treatment for each cause
- Danger signs and referral criteria
- Prevention and infection-control advice
- Special situations: contact-lens users, newborns, suspected STI, herpes infection
Brief overview: Conjunctivitis, often called pink eye, is inflammation of the conjunctiva, the thin membrane lining the eyelids and covering the white of the eye. It commonly produces diffuse redness, tearing, grittiness, burning, and discharge. Vision is usually normal. Itching is particularly suggestive of allergic conjunctivitis, while marked pain, photophobia, reduced vision, or a strong foreign-body sensation suggest corneal or deeper eye disease rather than simple conjunctivitis. Kanski's Clinical Ophthalmology, 10th ed., p. 185.
The common patterns overlap: viral disease often causes watery discharge and is contagious; bacterial disease often causes mucopurulent discharge and eyelids stuck together on waking; allergic disease tends to be bilateral and intensely itchy, often with allergy symptoms. Discharge alone cannot definitively establish the cause. Textbook of Family Medicine, 9e, red-eye evaluation section.
Most viral cases settle with supportive care and do not benefit from antibiotics. Mild bacterial cases can be self-limiting, though topical antibiotics may be used selectively. Allergic conjunctivitis is managed by allergen avoidance and anti-allergy treatment. The CDC clinical overview specifically advises urgent ophthalmic assessment for contact-lens wearers with suspected bacterial conjunctivitis because of the risk of bacterial keratitis.
A recent Cochrane-based systematic review found that antibiotics can improve clinical resolution in acute bacterial conjunctivitis (PMID: 37482371). Recent reviews also address topical therapies for allergic conjunctivitis (PMID: 40348333) and corticosteroid use in infective disease (PMID: 40059644), but steroid eye drops should not be self-started because they can worsen or mask infections such as herpes and require eye-specialist guidance.
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Conjunctivitis: concise overview
Conjunctivitis is inflammation of the conjunctiva, the transparent membrane covering the white part of the eye and lining the inner eyelids. It causes a red eye, discharge, tearing, irritation or grittiness, and sometimes lid swelling. Visual acuity is usually normal. The main causes are viral, bacterial, allergic, chemical/irritant, and less commonly chlamydial, gonococcal, or herpetic infection.
Typical clinical patterns
| Type | Key symptoms/signs | Contagious? | Usual management |
|---|---|---|---|
| Viral | Watery discharge, red eye, gritty sensation, often starts in one eye then affects the other; may have cold symptoms and tender preauricular node | Yes | Cold compresses, artificial tears, hygiene. Antibiotics do not help. |
| Bacterial | Mucopurulent or purulent discharge, eyelids matted on waking, redness | Often | Cleaning discharge; clinician may prescribe topical antibiotic in selected cases. |
| Allergic | Intense itching, watery/stringy discharge, both eyes involved, often with sneezing/rhinitis | No | Avoid allergen, cool compresses, lubricants, antihistamine/mast-cell stabilizer eye drops. |
| Chemical/irritant | Burning and tearing after smoke, chlorine, cosmetics, or chemical exposure | No | Immediate irrigation and medical evaluation for significant exposure. |
| Chlamydial | Persistent unilateral red eye with mucopurulent discharge and follicles | Sexually transmitted | Systemic antibiotic treatment and partner management. |
| Gonococcal | Sudden severe redness, copious hyperpurulent discharge, marked lid swelling | Yes | Urgent emergency ophthalmology care due to risk of corneal perforation. |
| Herpetic | Often unilateral watery red eye, possible eyelid vesicles, corneal involvement | Potentially | Urgent eye assessment. Do not use steroid drops unless prescribed by an ophthalmologist. |
Symptoms suggesting simple conjunctivitis: diffuse redness, irritation, discharge, and normal vision.
Symptoms not typical of simple conjunctivitis: significant pain, marked photophobia, reduction in vision, abnormal pupil, corneal opacity, or a severe foreign-body sensation. These may indicate keratitis, uveitis, acute glaucoma, or corneal ulceration. Kanski's Clinical Ophthalmology, 10th ed., p. 185.
Symptoms not typical of simple conjunctivitis: significant pain, marked photophobia, reduction in vision, abnormal pupil, corneal opacity, or a severe foreign-body sensation. These may indicate keratitis, uveitis, acute glaucoma, or corneal ulceration. Kanski's Clinical Ophthalmology, 10th ed., p. 185.
Important self-care measures
- Wash hands frequently.
- Avoid touching or rubbing the eyes.
- Do not share towels, pillows, eye cosmetics, or eye drops.
- Clean discharge gently with clean water and a fresh cotton pad or tissue.
- Avoid contact lenses until symptoms completely resolve and an eye clinician says they can be restarted.
- Use cool compresses and preservative-free artificial tears for comfort.
- Do not use someone else’s antibiotic drops or steroid-containing drops.
The CDC guidance notes that most mild viral conjunctivitis resolves without treatment, often within 7-14 days. Mild bacterial conjunctivitis can also resolve without antibiotics, though a clinician may prescribe topical antibiotics to shorten illness or reduce complications in suitable cases.
Seek urgent medical attention today if
- Vision becomes blurred or reduced
- There is moderate or severe eye pain
- Light causes pain or marked discomfort
- You wear contact lenses and develop a red eye
- There is a corneal white spot, severe lid swelling, injury, or chemical splash
- There is copious thick pus, especially with rapidly worsening redness
- You have eyelid blisters or suspected herpes
- A newborn has a red, swollen, or discharging eye
- Symptoms worsen or do not begin improving after a few days
Contact-lens wearers with red eye need prompt assessment because bacterial keratitis can threaten vision, as highlighted in the CDC clinical overview.
Recent systematic-review evidence indicates that antibiotics can improve clinical resolution in acute bacterial conjunctivitis, but they are not useful for viral conjunctivitis (PMID: 37482371).
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