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{{Conjunctivitis}}
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==Overview==
==Overview==
Laboratory tests are not often required as conjunctivitis is often treated empirically.  
Laboratory tests are not often required in patients with mild conjunctivitis. Conjunctival cultures are generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[mucopurulent discharge]], and cases suspicious for [[gonococcal]] or [[chlamydial]] infection.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid17491982">{{cite journal| author=Wood M| title=Conjunctivitis: diagnosis and management. | journal=Community Eye Health | year= 1999 | volume= 12 | issue= 30 | pages= 19-20 | pmid=17491982 | doi= | pmc=1706007 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17491982  }} </ref>


==Laboratory Findings==
==Laboratory Findings==
===Bacterial Culture===
Laboratory tests usually are not required in patients with mild conjunctivitis. However, specimens for [[bacterial cultures]] should be obtained in patients who have severe [[inflammation]] with [[mucopurulent discharge]], chronic conjunctivitis, and recurrent conjunctivitis. Cultures also should be obtained in patients who do not respond to treatment.<ref name="pmid17491982">{{cite journal| author=Wood M| title=Conjunctivitis: diagnosis and management. | journal=Community Eye Health | year= 1999 | volume= 12 | issue= 30 | pages= 19-20 | pmid=17491982 | doi= | pmc=1706007 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17491982  }} </ref>
Swabs for bacterial culture are necessary if the history & signs suggest bacterial conjunctivitis, but there is no response to topical [[antibiotic]]s. Research studies indicate that many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so negative results are common. Viral culture may be appropriate in epidemic case clusters.  Conjunctival scrapes for [[cytology]] can be useful in detecting [[chlamydial]] and [[fungal]] infections, [[allergy]] and [[dysplasia]], but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens.  Conjunctival incisional [[biopsy]] is occasionally done when granulomatous diseases (e.g., [[sarcoidosis]]) or [[dysplasia]] are suspected.
===Viral Conjunctivitis===
In general, viral conjunctivitis is diagnosed based on clinical features alone. Laboratory findings for viral conjunctivitis may include the following:<ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref>
*Positive conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]] (PCR testing for HSV is more sensitive than viral culture)
*Positive viral culture of corneal epithelial cells for [[HSV]]
===Bacterial Conjunctivitis===
Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required.
Swabs for [[bacterial]] culture is generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[mucopurulent discharge]], and cases suspicious for [[gonococcal]] or [[chlamydial]] infection.<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref>
====Chlamydial Infection====
Laboratory studies for chlamydial conjunctivitis may include the following:<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref>
*Positive [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scraping
*Positive [[gram staining]] or giemsa staining of conjunctival scraping(help characterize the conjunctival [[inflammatory response]])
*Positive [[DNA hybridization]] assays
*Direct fluorescent monoclonal antibody staining of smears
*Positive enzyme immuno-assays for chlamydia organisms
====Gonococcal Infection====
Laboratory findings for gonococca conjunctivitis may include the following:<ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref>
*Positive [[gram staining]] of conjunctival scraping for [[gram-negative]] intra-cellular [[diplococci]]
*Positive special cultures for [[neisseria]] species on [[chocolate agar]] or Thayer-Martin
===Neonatal Conjunctivitis===
Laboratory findings for neonatal conjunctivitis may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*Positive [[gram staining]] or [[giemsa]] staining of conjunctival scraping
*Positive [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scraping ([[chlamydia]], [[gonorrhea]], and [[HSV]])
*Positive special cultures for [[neisseria]] species on [[chocolate agar]] or Thayer-Martin
*Positive culture on [[blood agar]]
*Positive viral culture of corneal epithelial cells for [[HSV]] (cornea is involvement)
 
===Allergic Conjunctivitis===
Most cases are mild, and the patient just needs [[reassurance]]. Laboratory studies for allergic conjunctivitis should include the following:<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue=  | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref>
*[[Eosinophilia]] in superficial conjunctival scraping (severe cases)
*An elevated various inflammatory mediators (such as [[IgE]], [[histamine]], and [[tryptase]]) in tear
*Positive [[skin testing]] (may provide definitive diagnosis)
===Keratoconjunctivitis Sicca===
Diagnosis of [[keratoconjunctivitis sicca|keratoconjunctivitis sicca (dry eye syndrome)]] is generally made by the combination of history, physical examination, and one or more laboratory findings.
Laboratory findings for keratoconjunctivitis sicca may include the following:<ref name="pmid19668387">{{cite journal| author=Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E| title=The challenge of dry eye diagnosis. | journal=Clin Ophthalmol | year= 2008 | volume= 2 | issue= 1 | pages= 31-55 | pmid=19668387 | doi= | pmc=2698717 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19668387  }} </ref><ref name="pmid26766898">{{cite journal| author=Beckman KA, Luchs J, Milner MS| title=Making the diagnosis of Sjögren's syndrome in patients with dry eye. | journal=Clin Ophthalmol | year= 2016 | volume= 10 | issue=  | pages= 43-53 | pmid=26766898 | doi=10.2147/OPTH.S80043 | pmc=4699514 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26766898 }} </ref>
*Tear osmolarity of 316 mOsm/L or greater(best single diagnostic test)
*An abnormal colored tear film interferometry (measure lipid layer thickness)
*Positive serology for circulating [[autoantibodies]] ([[Sjö test]])
**[[Antinuclear antibody|Antinuclear antibody (ANA)]]
**[[Rheumatoid factor|Rheumatoid factor (RF)]]
**Anti Ro antibody (SS-A)
**Anti La antibody (SS-B)
**Salivary gland protein 1 antibody (SP-1)
**Carbonic anhydrase 6 antibody (CA6)
**Parotid secretory protein antibody (PSP)
===Superior Limbic Keratoconjunctivitis===
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] has been associated with thyroid dysfunction. Therefore, laboratory findings for superior limbic keratoconjunctivitis may include the following:<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref><ref name="pmid6493706">{{cite journal| author=Passons GA, Wood TO| title=Conjunctival resection for superior limbic keratoconjunctivitis. | journal=Ophthalmology | year= 1984 | volume= 91 | issue= 8 | pages= 966-8 | pmid=6493706 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6493706  }} </ref>
*An abnormal [[thyroid-stimulating hormone|thyroid-stimulating hormone (TSH)]]
*An abnormal free [[thyroxine|thyroxine (T4)]]
*Positive [[Thyroid peroxidase|anti thyroid peroxidase antibody]]
*Positive [[antithyroglobulin antibody]]


==References==
==References==
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Latest revision as of 21:07, 29 July 2020

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

Overview

Laboratory tests are not often required in patients with mild conjunctivitis. Conjunctival cultures are generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe mucopurulent discharge, and cases suspicious for gonococcal or chlamydial infection.[1][2]

Laboratory Findings

Laboratory tests usually are not required in patients with mild conjunctivitis. However, specimens for bacterial cultures should be obtained in patients who have severe inflammation with mucopurulent discharge, chronic conjunctivitis, and recurrent conjunctivitis. Cultures also should be obtained in patients who do not respond to treatment.[2]

Viral Conjunctivitis

In general, viral conjunctivitis is diagnosed based on clinical features alone. Laboratory findings for viral conjunctivitis may include the following:[3][4]

  • Positive conjunctival scraping for polymerase chain reaction (PCR) (PCR testing for HSV is more sensitive than viral culture)
  • Positive viral culture of corneal epithelial cells for HSV

Bacterial Conjunctivitis

Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required. Swabs for bacterial culture is generally reserved for recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe mucopurulent discharge, and cases suspicious for gonococcal or chlamydial infection.[5][6]

Chlamydial Infection

Laboratory studies for chlamydial conjunctivitis may include the following:[7]

Gonococcal Infection

Laboratory findings for gonococca conjunctivitis may include the following:[8]

Neonatal Conjunctivitis

Laboratory findings for neonatal conjunctivitis may include the following:[9]

Allergic Conjunctivitis

Most cases are mild, and the patient just needs reassurance. Laboratory studies for allergic conjunctivitis should include the following:[10]

Keratoconjunctivitis Sicca

Diagnosis of keratoconjunctivitis sicca (dry eye syndrome) is generally made by the combination of history, physical examination, and one or more laboratory findings. Laboratory findings for keratoconjunctivitis sicca may include the following:[11][12]

  • Tear osmolarity of 316 mOsm/L or greater(best single diagnostic test)
  • An abnormal colored tear film interferometry (measure lipid layer thickness)
  • Positive serology for circulating autoantibodies (Sjö test)

Superior Limbic Keratoconjunctivitis

Superior limbic keratoconjunctivitis (SLK) has been associated with thyroid dysfunction. Therefore, laboratory findings for superior limbic keratoconjunctivitis may include the following:[13][14]

References

  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.
  2. ↑ 2.0 2.1 Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.
  3. ↑ Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH (2015). "The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil". Clinics (Sao Paulo). 70 (11): 748–50. doi:10.6061/clinics/2015(11)06. PMC 4642493. PMID 26602522.
  4. ↑ 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.
  5. ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  6. ↑ Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis". J Infect Dis. 153 (5): 862–9. PMID 3084664.
  7. ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  8. ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E (2008). "The challenge of dry eye diagnosis". Clin Ophthalmol. 2 (1): 31–55. PMC 2698717. PMID 19668387.
  12. ↑ Beckman KA, Luchs J, Milner MS (2016). "Making the diagnosis of Sjögren's syndrome in patients with dry eye". Clin Ophthalmol. 10: 43–53. doi:10.2147/OPTH.S80043. PMC 4699514. PMID 26766898.
  13. ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
  14. ↑ Passons GA, Wood TO (1984). "Conjunctival resection for superior limbic keratoconjunctivitis". Ophthalmology. 91 (8): 966–8. PMID 6493706.

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