Conjunctivitis laboratory findings: Difference between revisions
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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]
- Positive 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:[8]
- 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:[9]
- Positive gram staining or giemsa staining of conjunctival scraping
- Positive 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:[10]
- 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 (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)
- Antinuclear antibody (ANA)
- 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 (SLK) has been associated with thyroid dysfunction. Therefore, laboratory findings for superior limbic keratoconjunctivitis may include the following:[13][14]
- An abnormal thyroid-stimulating hormone (TSH)
- An abnormal free thyroxine (T4)
- Positive anti thyroid peroxidase antibody
- Positive antithyroglobulin antibody
References
- ↑ 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.
- ↑ 2.0 2.1 Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.
- ↑ 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.
- ↑ 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.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ 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.
- ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
- ↑ Passons GA, Wood TO (1984). "Conjunctival resection for superior limbic keratoconjunctivitis". Ophthalmology. 91 (8): 966–8. PMID 6493706.