Bacterial Conjunctivitis Workup

Author: Karen K Yeung, OD, FAAO; Chief Editor: Hampton Roy Sr, MD more...

Updated: Nov 3, 2011

What would you like to print?

Approach Considerations
Conjunctival Scrapings and Cultures
Show All

Approach Considerations

Conjunctival scrapings and cultures are frequently obtained in severe bacterial conjunctivitis or those cases when antibacterial therapy is ineffective. Imaging studies do not play a significant role in the workup of bacterial conjunctivitis unless an underlying condition is suspected. For example, 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.

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.

Conjunctival Scrapings and Cultures

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.

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.

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.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Karen K Yeung, OD, FAAO Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California, Los Angeles, David Geffen School of Medicine

Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry

Disclosure: Nothing to disclose.

Coauthor(s)

David S Marlin, MD Consulting Staff, Department of Ophthalmology, Kaiser Foundation Hospital, Los Angeles Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Jerre Freeman, MD Founder, Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center College of Medicine

Jerre Freeman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

References

Tabbara KF, Hyndiuk RA. Infections of the Eye. Little, Brown and Company; 1996.
Rapoza PA, Quinn TC, Kiessling LA, Taylor HR. Epidemiology of neonatal conjunctivitis. Ophthalmology. Apr 1986;93(4):456-61. [Medline].
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].
Schachter J, Lum L, Gooding CA, Ostler B. Pneumonitis following inclusion blennorrhea. J Pediatr. Nov 1975;87(5):779-80. [Medline].
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].

View Table List

Read more about Bacterial Conjunctivitis on Medscape