Definition: “Pink-eye” is a rather common complaint of patients in the primary care setting and many cases are self-limiting or will improve with the use of antibiotics, depending on the etiology. Conjunctivitis is simply defined as inflammation involving the lining of the eyeball and lid. There are multiple factors that may cause conjunctivitis. The most common causes will be discussed within this article, as well as red flags that warrant immediate evaluation by an ophthalmologist.
There are two main causes of conjunctivitis: Infectious (bacterial, viral, chlamydial) and Non-infectious (allergies, irritants). The table below summarizes these causes and the likely presenting symptoms for each type and their recommended treatment.
Red Flags: There are some specific exam findings that should prompt the provider to refer that patient to ophthalmology.
- Reduced visual acuity: If you have a patient who complains of acute onset of reduced visual changes, this is concerning for possible ocular problems such as angle closure glaucoma, iritis or even infectious keratitis.
- Ciliary flush: Ring of pronounced injection most notable at the limbus. This raises concern for infectious keratitis, iritis and angle closure glaucoma
- Photophobia: Increased sensitivity to light may be concerning for infectious keratitis, iritis or corneal abrasion
- Severe foreign body sensation and pain: When a patient is unable to keep their eye open due to the pain or discomfort, this could be due to corneal inflammation, ulceration, uveitis scleritis or glaucoma
- Corneal opacity: Concerning for acute glaucoma, uveitis or infectious keratitis
- Fixed pupil: Concerning for acute glaucoma or uveitis
- Headache/nausea: May be indicative of angle-closure glaucoma
- Purulent discharge with hyperemia: Indicative of possible gonococcal conjunctivitis
Pearls and patient teaching points: There has been past use of glucocorticoids with acute conjunctivitis, but is NOT recommended to be used in the primary care setting. UpToDate notes that use of glucocorticoids have the potential to cause “sight-threatening complications when used inappropriately.” Such complications may include scarring, melting and perforation.
When educating patients regarding treatment, it is important to educate them on the importance of routine handwashing, as viral and bacterial conjunctivitis are highly contagious. Additionally, when using eye drops, avoid touching the dropper directly on the eye or sharing medication with others. Lastly, if a patient wears contacts, they may need to refrain from wearing them temporarily. They may need to also clean their contacts thoroughly and purchase a new contact case to avoid continued contamination.
By Tracy Lindstrom RN, BSN, DNP-S
Cronau, H., KanKanala, R., Mauger, T. (2010). Diagnosis and management of red eye in primary care. American Family Physician. 81(2). 137-144
Hovding, G. (2006). Acute bacterial conjunctivitis. Acta Ophthalmol. 86(1). 5-17
Jacobs, D., Trobe, J., Park, L. (2015). Conjunctivitis. Obtained from http://www.uptodate.com.proxy.wichita.edu/contents/conjunctivitis?source=search_result&search=conjunctivitis&selectedTitle=1~150#H1
Leibowitz, H. (2000). The red eye. New England Journal of Medicine. 343(5). 345-351
Ossorio, A. (2015). Red eye emergencies in primary care. The Nurse Practitioner. 40(12). 47-53
Sambursky, R., Raykovicz, L., Ehrenhaus, M., Fraser, S. (2014). Acute conjunctivitis. Epocrates