Conjunctivitis laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(41 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Conjunctivitis}}
{{Conjunctivitis}}
{{CMG}} {{AE}} {{SaraM}}
{{CMG}}; {{AE}} {{SaraM}}


==Overview==
==Overview==
Laboratory tests are not often required as conjunctivitis is often treated empirically. Obtaining conjunctival cultures is generally reserved for cases of suspected infectious neonatal conjunctivitis, recurrent conjunctivitis, conjunctivitis recalcitrant to therapy, conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for ''[[gonococcal]]'' or ''[[chlamydial]] infection.
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==
Laboratory tests usually are not required in patients with mild conjunctivitis of suspected [[viral]], [[bacterial]] or [[allergic]] origin. However, specimens for bacterial cultures should be obtained in patients who have severe [[inflammation]] (hyperacute [[purulent]] conjunctivitis) or [[chronic]] or recurrent conjunctivitis. Cultures also should be obtained in patients who do not respond to treatment.
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>
===Viral Conjunctivitis===
===Viral Conjunctivitis===
In-office rapid [[antigen]] testing is available for ''[[adenoviruses]]'' and has 89% [[sensitivity]] and up to 94% [[specificity]]. This test can identify the [[viral]] causes of conjunctivitis and prevent unnecessary [[antibiotic]] use.
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===
===Bacterial Conjunctivitis===
Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required.  
Acute bacterial conjunctivitis is usually self-limited and laboratory tests usually are not required.  
Swabs for [[bacterial]] culture is generally reserved for cases of suspected infectious neonatal conjunctivitis ([[ophthalmia neonatorum]]), recurrent conjunctivitis, conjunctivitis recalcitrant to [[therapy]], conjunctivitis presenting with severe [[purulent]] discharge, and cases suspicious for ''[[gonococcal]]'' or ''[[chlamydial]] infection.
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====
====Chlamydial Infection====
Several laboratory procedures can be used to identify ''[[chlamydial]]'' infections. These include [[cell culture]], direct [[fluorescent]] [[monoclonal antibody]] [[staining]] of smears, [[enzyme]] immuno-assays for ''Chlamydia'' [[organisms]], [[DNA hybridization]] assays and a [[polymerase chain reaction]] test to identify chlamydial [[antigens]].
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>
Many [[ophthalmologists]] obtain conjunctival [[cytology]] scrapings for [[Gram staining]] and/or [[Giemsa]] staining to help characterize the conjunctival [[inflammatory response]]. The findings can be helpful, particularly for diagnosing [[allergic]], ''chlamydial'' and certain atypical forms of conjunctivitis in which the clinical diagnosis is not immediately apparent.
*Positive [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scraping
Conjunctival scrapes for [[cytology]] are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens.
*Positive [[gram staining]] or giemsa staining of conjunctival scraping(help characterize the conjunctival [[inflammatory response]])
====''Gonococcal'' Infection====
*Positive [[DNA hybridization]] assays
The diagnostic work-up for a ''[[gonococcal]]'' ocular infection includes immediate [[Gram staining]] of specimens for [[gram-negative]] intra-cellular [[diplococci]], as well as special cultures for ''[[neisseria]]'' species on chocolate agar or Thayer-Martin.
*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===
===Neonatal Conjunctivitis===
Laboratory studies for neonatal conjunctivitis should include the following:
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>
Conjunctival scraping for [[gram stain]] or [[giemsa]] stain
*Positive [[gram staining]] or [[giemsa]] staining of conjunctival scraping
Conjunctival scraping for polymerase chain reaction assay (PCR) to detect chlamydia and gonorrhea
*Positive [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scraping ([[chlamydia]], [[gonorrhea]], and [[HSV]])
Culture on chocolate agar and/or Thayer-Martin for N gonorrhoeae
*Positive special cultures for [[neisseria]] species on [[chocolate agar]] or Thayer-Martin
Culture on blood agar for other bacteria
*Positive culture on [[blood agar]]
Culture of corneal epithelial cells for HSV if cornea is involved; PCR should also be considered in cases of possible HSV conjunctivitis
*Positive viral culture of corneal epithelial cells for [[HSV]] (cornea is involvement)
 
===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
Most cases are mild, and the patient just needs reassurance.
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>
Superficial conjunctival [[scrapings]] may help to establish the diagnosis by revealing [[eosinophils]], but only in the most severe cases, since eosinophils are typically present in the deeper layers of the [[substantia propria]] of the conjunctiva. Therefore, the absence of eosinophils on conjunctival scraping does not rule out the diagnosis of allergic conjunctivitis.
*[[Eosinophilia]] in superficial conjunctival scraping (severe cases)
Measurement of tear levels of various [[inflammatory mediators]], such as [[IgE]], [[histamine]], and [[tryptase]], as indicators of allergic activity.
*An elevated various inflammatory mediators (such as [[IgE]], [[histamine]], and [[tryptase]]) in tear
Additionally, skin testing by an [[allergist]] may provide definitive diagnosis. Skin testing is now highly practical.
*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>
Conjunctival incisional [[biopsy]] is occasionally done when granulomatous diseases (e.g., [[sarcoidosis]]) or [[dysplasia]] are suspected.
*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==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Inflammations]]
[[Category:Ophthalmology]]
[[Category:Overview complete]]
[[Category:Disease]]
[[Category:Primary care]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Ophthalmology]]
[[Category:Immunology]]
[[Category:Pediatrics]]
[[Category:Endocrinology]]
[[Category:Rheumatology]]
[[Category:FinalQCRequired]]

Latest revision as of 21:07, 29 July 2020

Conjunctivitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Conjunctivitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Conjunctivitis laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Conjunctivitis laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Conjunctivitis laboratory findings

CDC on Conjunctivitis laboratory findings

Conjunctivitis laboratory findings in the news

Blogs on Conjunctivitis laboratory findings

Directions to Hospitals Treating Conjunctivitis

Risk calculators and risk factors for Conjunctivitis laboratory findings

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.

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Conjunctivitis_laboratory_findings&oldid=1636499"