eMedicine Specialties > Ophthalmology > Conjunctiva
Conjunctivitis, Bacterial: Differential Diagnoses & Workup
Updated: Jun 1, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Nongranulomatous iritis
Workup
Laboratory Studies
- Conjunctival scrapings and cultures most often are used in laboratory studies.
- Cultures can be completed for viral, chlamydial, and bacterial agents.
- If testing for N gonorrhoeae, specific procedures should be followed to optimize the yield.
- Fungal culture would be unusual, except in the setting of a corneal ulcer or in the case of known contamination of a contact lens solution such as occurred in early 2006.
- Conjunctival scrapings can be performed with topical anesthetic and gentle use of a platinum spatula or similar blunt metallic object.
- Gram stain is useful to identify bacterial characteristics.
- Giemsa stain is helpful to screen for intracellular inclusion bodies of Chlamydia.
- Additionally, the nature of the inflammatory reaction is reflected in the cellular response. Lymphocytes predominate in viral infections, neutrophils in bacterial infections, and eosinophils in allergic reactions.
Imaging Studies
- Imaging studies do not play a significant role in the workup of bacterial conjunctivitis unless an underlying condition, such as sinusitis, is suspected.
- MRA, CT scan, and orbital color Doppler may play a role in a suspected cavernous sinus fistula.
- Orbital CT scan may be indicated to rule out an orbital abscess or pansinusitis, when the conjunctivitis is part of an orbital cellulitis.
Procedures
- Certain procedures may address a known or suspected underlying cause for conjunctivitis or conditions that mimic it.
- Removal of offending lashes with epilation forceps or by electrolysis may be indicated for trichiasis.
- Nasolacrimal duct irrigation may be attempted to see if an obstruction that predisposes to infection is present. An obstruction should be suspected in chronic and intermittent purulent conjunctivitis.
- Eversion of the eyelid at the slit lamp is indicated when a foreign body is suspected.
Histologic Findings
Gram and Giemsa stains in the presence of bacteria demonstrate the expected inflammatory cell response in the stroma. However, this consideration is only academic because the condition is not an indication for biopsy. Cultures and scrapings are usually diagnostic.
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| Overview: Conjunctivitis, Bacterial |
 Differential Diagnoses & Workup: Conjunctivitis, Bacterial |
| Treatment & Medication: Conjunctivitis, Bacterial |
| Follow-up: Conjunctivitis, Bacterial |
| References |
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References
Hammerschlag MR, Cummings C, Roblin PM, Williams TH, Delke I. Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med. Mar 23 1989;320(12):769-72. [Medline].
Rapoza PA, Quinn TC, Kiessling LA, Taylor HR. Epidemiology of neonatal conjunctivitis. Ophthalmology. Apr 1986;93(4):456-61. [Medline].
Schachter J, Lum L, Gooding CA, Ostler B. Pneumonitis following inclusion blennorrhea. J Pediatr. Nov 1975;87(5):779-80. [Medline].
Tabbara KF, Hyndiuk RA. Infections of the Eye. Little, Brown and Company; 1996.
Ullman S, Roussel TJ, Culbertson WW, Forster RK, Alfonso E, Mendelsohn AD, et al. Neisseria gonorrhoeae keratoconjunctivitis. Ophthalmology. May 1987;94(5):525-31. [Medline].
Further Reading
Keywords
bacterial conjunctivitis, eye infection, pink eye, red eye
