eMedicine Specialties > Emergency Medicine > Ophthalmology

Conjunctivitis: Follow-up

Author: Michael A Silverman, MD, Instructor of Emergency Medicine, The Johns Hopkins University School of Medicine; Chairman, Department of Emergency Medicine, Harbor Hospital
Coauthor(s): Edward Bessman, MD, Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Further Inpatient Care

  • Patients with gonorrheal infections, neonates with infections, and patients who are immunocompromised should be admitted for administration of IV antibiotics.

Further Outpatient Care

  • Refer patients to their primary care provider for follow-up in 2-3 days to ensure they are responding to treatment. Viral conjunctivitis usually is self-limited to 10-14 days, but symptoms may persist for as many as 6 weeks.

Inpatient & Outpatient Medications

  • Prescribe one of the previously mentioned antibiotics for discharged patients. For copious ocular secretions, patients may use frequent saline irrigation or artificial tears. Avoid eye patching.

Transfer

  • Manage simple conjunctivitis in the ED. Transfer may be appropriate for patients with complications from chronic or gonococcal conjunctivitis when an ophthalmologist is unavailable.

Deterrence/Prevention

  • Careful and frequent hand washing is necessary to reduce transmission from one eye to the other in the patient and from contacts.

Complications

  • Pneumonia can occur in 10-20% of infants with chlamydial conjunctivitis as many as 6 months later. Untreated chlamydial conjunctivitis in adults can lead to conjunctival scarring.
  • Penetration of the cornea can occur within 2 days in patients with untreated N gonorrhoeae.
  • Infections with N meningitidis may require systemic antibiotics to prevent meningitis.

Prognosis

  • Prognosis is good. Conjunctivitis typically is self-limited and without long-term complications.

Patient Education

  • Warm compresses and washing eyelids with diluted baby shampoo may speed resolution when blepharitis is an associated factor. Patients should not use eye makeup. Frequent hand washing is essential to prevent further transmission.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Pinkeye.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize a gonococcal infection in someone with ocular and GU symptoms
  • Failure to recognize herpes simplex conjunctivitis and keratitis and prescribing corticosteroids
  • Failure to consider other causes in a patient with an acutely red eye (eg, iritis, uveitis, angle-closure glaucoma, ocular ischemic syndrome, penetrating or perforating ocular injury)

Special Concerns

  • During birth, risk of transmission of Gonococcus, Streptococcus, or Chlamydia to the fetus exists. Obtain cervical cultures if indicated.
  • Risk of chlamydial pneumonia exists. Any of the bacterial organisms that cause conjunctivitis, particularly in a premature infant, can lead to sepsis and death. Neonates are at risk for secondary meningitis, cellulitis, and septicemia, particularly if the conjunctivitis is caused by Escherichia coli, Staphylococcus aureus, or Haemophilus influenzae.
 


More on Conjunctivitis

Overview: Conjunctivitis
Differential Diagnoses & Workup: Conjunctivitis
Treatment & Medication: Conjunctivitis
Follow-up: Conjunctivitis
References
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References

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Further Reading

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Contributor Information and Disclosures

Author

Michael A Silverman, MD, Instructor of Emergency Medicine, The Johns Hopkins University School of Medicine; Chairman, Department of Emergency Medicine, Harbor Hospital
Michael A Silverman, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Edward Bessman, MD, Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University
Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William K Chiang, MD, Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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