Conjunctivitis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [3]
Overview
Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicrosopy, laboratory tests are often necessary to determine the underlying pathophysiology with certainty. perform an eye examination can help to differentiating conjunctivitis from other medical conditions.[1]
Bacterial Conjunctivitis
A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae and Chlamydia trachomatis should be suspected if the discharge is particularly thick and copious. Bacterial conjunctivitis must be differentiated from:[1]
- Viral conjunctivitis
- Keratoconjunctivitis sicca
- Glaucoma
- Blepharitis
- Uveitis
- Iritis
- Keratitis.
- Episcleritis
- Scleritis
- Meningitis
Neisseria meningitis is also in the differential, and it is important to consider as it can lead to fatal meningeal or systemic infection in the patient with hyperacute conjunctivitis due to Neisseria gonorrhoeae.
Viral Conjunctivitis
A diffuse, highly contagious, characterized by watery discharge, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy. Viral Conjunctivitis must be differentiated from:
- Keratoconjunctivitis
- Nasolacrimal duct obstruction
- Foreign body
- Keratitis
- Uveitis
- Pharyngoconjunctival fever
Neonatal conjunctivitis
Neonatal conjunctivitis must be differentiated from:[2]
- Dacrocysitis
- Congenital glaucoma
- Nasolacrimal duct obstruction
- Preseptal/Orbital cellulitis
- Keratitis
Allergic conjunctivitis
Allergic conjunctivitis must be differentiated from:[3]
- Viral conjunctivitis
- Bacterial conjunctivitis
Allergic conjunctivitis has a protracted course, with the severity of symptoms waxing and waning throughout the allergy season. As recurrences within a short period of time are unlikely with bacterial or viral conjunctivitis.
Keratoconjunctivitis sicca
Dry eye syndrome (DES), or keratoconjunctivitis sicca must be differentiated from:[4][5]
- Allergic conjunctivitis (Atopic, and vernal keratoconjunctivitis)
- Blepharitis
- Bell Palsy
- Superior limbic keratoconjunctivitis
- Thyroid ophthalmopathy
Superior limbic keratoconjunctivitis
Superior limbic keratoconjunctivitis is chronic condition with remission and exacerbations, and it must be differentiated from:[6]
- Infective conjunctivitis
- Allergic conjunctivitis
- Dry eye syndrome (DES)
- Thyroid ophthalmopathy
- Ocular surface squamous neoplasia
- Sebaceous gland carcinoma
References
- ↑ 1.0 1.1 American Academy of ophthalmology (2016) http://eyewiki.aao.org/Bacterial_Conjunctivitis Accessed on June 27, 2016
- ↑ American Academy of Ophthalmology (2014) [1] Accessed on June 27, 2016
- ↑ American Academy of Ophthalmology (2014) Accessed on June 27, 2016 http://eyewiki.org/Allergic_conjunctivitis
- ↑ Zhang X, Zhao L, Deng S, Sun X, Wang N (2016). "Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics". J Ophthalmol. 2016: 8201053. doi:10.1155/2016/8201053. PMC 4861815. PMID 27213053.
- ↑ Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E; et al. (2016). "Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease". Ocul Surf. doi:10.1016/j.jtos.2016.04.003. PMID 27179980.
- ↑ American Academy of Ophthalmology (2015) http://eyewiki.aao.org/Superior_limbic_keratoconjunctivitis Accessed on June 27, 2016
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