eMedicine Specialties > Emergency Medicine > Ophthalmology

Conjunctivitis: Treatment & Medication

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

Treatment

Prehospital Care

Prehospital transport rarely is indicated for patients with conjunctivitis. More serious concerns may warrant emergency medical services (EMS) transport. Prehospital personnel should not overlook more serious comorbidity; they should focus on preventing transmission. Thorough hand washing by EMS personnel and glove use are necessary.

Treatment often is supportive. Artificial tears help the discomfort of keratitis and photophobia. Cold compresses improve the swelling and discomfort of the lids. Antibiotic drops help prevent a secondary bacterial infection. Reserve topical corticosteroids for use by an ophthalmologist when substantial inflammation is present and herpes simplex is excluded. Broad-spectrum antibiotics, such as Ciloxan (ciprofloxacin) or Ocuflox (ofloxacin), are good choices. Sulfacetamide is also acceptable. Aminoglycoside is toxic to epithelia and retards healing. Polytrim (trimethoprim/sulfamethoxazole) is a reasonable choice particularly in children.

Emergency Department Care

Physicians and other medical personnel must be careful not to transmit this infection. Prevention of transmission includes thorough hand washing and using eye drops in individual or unit dose containers. Patients can be given moist compresses for comfort.

For treatment guidelines, see the American Academy of Ophthalmology's guidelines.1

Consultations

Consult with an ophthalmologist for all serious eye complaints. Simple conjunctivitis usually can be followed up by the patient's primary care provider. Discuss with an ophthalmologist solutions to questions or equivocal diagnosis. Neisserial conjunctivitis is an ocular emergency and should be viewed as an ocular finding of systemic disease. Ophthalmologic consultation is essential.

Medication

Treatment with antimicrobials and symptomatic therapy is recommended for all patients initially presenting to the ED with simple conjunctivitis. Numerous topical antimicrobial agents may be used, including topical sulfacetamide, erythromycin, gentamicin, ciprofloxacin, or ofloxacin. Avoid neomycin-containing solutions because 8-15% of patients have hypersensitivity reactions. Instill drops every 2 hours. An ointment can be used at night or every 4-6 hours throughout the day.

Consider gonococcal conjunctivitis part of a systemic disease, thus requiring systemic treatment. Inpatient medical regimens include cefoxitin, ceftriaxone, cefotaxime, or spectinomycin. Treat all patients who have chlamydia with tetracycline, doxycycline, azithromycin, or erythromycin. Outpatient therapy is acceptable in less serious cases in which compliance can be ensured and includes ceftriaxone (50 mg/kg, not to exceed 1 g) IV followed by doxycycline 100 mg twice a day or erythromycin 500 mg qid. Identify and treat patients' sexual partners.

Chlamydial conjunctivitis can be treated with doxycycline 100 mg twice a day for 10 days or azithromycin 1 g. Erythromycin can be used in pregnant patients and infants.

Topical therapy with erythromycin also is recommended and may speed resolution. As with gonococcal infections, identify and treat patients' sexual partners.

Antibiotics, ophthalmic

Used for infectious conjunctivitis. Therapy must cover all likely pathogens in the context of the clinical setting. However, when prescribing the antibiotic, the care provider must take into account that the incidence of MRSA has continued to increase in recent years.

The FDA has approved a new drug, besifloxacin, for the treatment of bacterial conjunctivitis.2

Ciprofloxacin 3% (Ciloxan)

Bactericidal antibiotic that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase in susceptible organisms. Broad-spectrum antibiotic with good gram-positive and gram-negative coverage.

Adult

1-2 gtt q2h in conjunctival sac(s) during waking hours for 2 d, then 1-2 gtt q4h during waking hours for the next 5 d

Pediatric

Not established

Documented hypersensitivity; viral, mycobacterial, and fungal infections of the eye

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

A white crystalline precipitate located in superficial portion of corneal defect may occur (onset in 1-7 d); precipitate usually is cleared within 2 wk and does not adversely affect clinical course or outcome; do not use in ocular infections that may become systemic; superinfections may occur with prolonged or repeated antibiotic therapy


Gatifloxacin ophthalmic solution 0.3% (Zymar)

Fourth-generation fluoroquinolone ophthalmic indicated for bacterial conjunctivitis. Elicits a dual mechanism of action by possessing an 8-methoxy group, thereby inhibiting the enzymes DNA-gyrase and topoisomerase IV. DNA gyrase is involved in bacterial DNA replication, transcription, and repair. Topoisomerase IV is essential in chromosomal DNA partitioning during bacterial cell division.
Indicated for bacterial conjunctivitis due to C propinquum, S aureus, S epidermidis, S mitis, S pneumoniae, or H influenzae.

Adult

Days 1-2: Instill 1 gtt into affected eye q2h while awake; not to exceed 8 administrations per day
Days 3-7: Instill 1 gtt into affected eye up to qid while awake

Pediatric

<1 year: Not established
>1 year: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For ophthalmic use only; commonly causes conjunctival irritation, increased lacrimation, corneal inflammation, or papillary conjunctivitis; less common adverse effects include conjunctival hemorrhage, dry eye, eye discharge, eye irritation, eye pain, eyelid swelling, headache, red eye, reduced visual acuity, or taste disturbance


Norfloxacin 0.3% (Noroxin, Chibroxin)

Inhibits bacterial growth by inhibiting DNA gyrase. Has limited use and is not readily available. Ciprofloxacin and ofloxacin are superior in spectrum and effectiveness. Approved for pediatric use in children >1 y.

Adult

1-2 gtt qid to affected eye for 7 d

Pediatric

<1 year: Not established
>1 year: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use in deep ocular infections likely to become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms


Besifloxacin ophthalmic (Besivance)

Quinolone antimicrobial ophthalmic susp indicated for bacterial conjunctivitis. Susceptible bacteria include CDC coryneform group G (Corynebacterium pseudodiphtheriticum, Corynebacterium stratum), Haemophilus influenza, Moraxella lacunata, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus lugdunensis, Streptococcus mitis, Streptococcus oralis, Streptococcus pneumoniae, and Streptococcus salivarius. Available as a 0.6% ophthalmic susp.

Adult

Instill 1 gtt in affected eye(s) tid (4-12 h between doses) for 7 d

Pediatric

<1 year: Not established
>1 year: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In clinical trials, adverse effects occurred in <3% of patients and included redness of eyes, blurred vision, eye pain, eye irritation, eye itching, and headache; do not use with contact lens (remove and do not wear contacts during course of therapy and with symptoms of bacterial conjunctivitis); for topical ophthalmic use only; prolonged use may lead to bacterial resistance


Bacitracin ointment 500 U/g (AK-Tracin, Baciguent)

Prevents transfer of mucopeptides into the growing cell wall, which results in inhibition of cell wall synthesis and, as a result, bacterial growth. Gram-positive better than gram-negative coverage.

Adult

Severe infections: Apply 0.25- to 0.5-in ribbon q3-4h into conjunctival sac for 7-10 d
Mild-to-moderate infections: Apply bid/tid

Pediatric

Not established

Documented hypersensitivity; vaccinia; varicella, epithelial herpes simplex keratitis; mycobacterial infections; fungal diseases of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Ophthalmic ointments may delay healing of corneal epithelia; in deep-seated infections of the eye, supplement with systemic medications; prolonged use may result in overgrowth of nonsusceptible organisms


Erythromycin ointment (Ilosone, E-Mycin)

Indicated for treatment of infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections. Good gram-positive coverage.

Adult

Apply 0.5-in (1.25-cm) ribbon to affected eye 2-8 times/d, depending on severity of infection

Pediatric

Administer as in adults
Prophylaxis of neonatal gonorrhea and chlamydia: Apply 0.5- to 1.25-cm ribbon to each conjunctival sac

Documented hypersensitivity; viral, mycobacterial, and fungal infections of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use topical antibiotics to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to a secondary infection (take appropriate measures if superinfection occurs)


Azithromycin ophthalmic (Azasite)

Ophthalmic macrolide antibiotic. Indicated for bacterial conjunctivitis caused by CDC coryneform group G bacteria, Haemophilus influenzae, Staphylococcus aureus, Streptococcus mitis group, and Streptococcus pneumoniae.

Adult

Instill 1 gtt in affected eye(s) bid (administer doses 8-12 h apart) for 2 d, then 1 gtt qd for next 5 d

Pediatric

<1 year: Not established
>1 year: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Thoroughly wash hands before using; for topical ophthalmic use only; prolonged use may result in resistant organisms; do not wear contact lenses until infection resolves; may cause eye irritation; less common adverse effects include burning, stinging, and/or irritation when instilled; other less common adverse effects include contact dermatitis, corneal erosion, dry eyes, dysgeusia, nasal congestion, ocular discharge, punctate keratitis, and sinusitis


Gentamicin (Garamycin, Genoptic)

Aminoglycoside antibiotic (ointment or solution) used for gram-negative bacterial coverage. Tends to be toxic to epithelia and retards healing.

Adult

Solution: 1-2 gtt q4h to affected eye
Ointment: Apply 0.5-in (1.25-cm) ribbon bid/tid q3-4h to affected eye

Pediatric

Administer as in adults

Documented hypersensitivity; mycobacterial, viral, and fungal infections of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to a secondary infections


Tobramycin (Tobrex, AKTob)

Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane. Available as a solution, ointment, and lotion. Superior to gentamicin in that streptococcal species are often resistant to gentamicin.

Adult

Solution: 1-2 gtt q4h to affected eye during waking hours and less frequently at night; in severe infections, instill 2 gtt q30-60 min initially, followed by less frequent intervals
Ointment: Apply 0.5-in ribbon bid/tid in conjunctival sac; in severe infections, apply q3-4h

Pediatric

<2 years: Not established
>2 years: Administer as in adults

Effects of this drug diminish when used concurrently with gentamicin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use in deep-seated ocular infections or in those that may become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms


Sulfacetamide 10% (Bleph-10, Sodium Sulamyd)

Inhibits folic acid synthesis, which results in inhibition of bacterial growth. Has better gram-positive than gram-negative coverage. Available as solution, ointment, and lotion.

Adult

Solution: 1-3 gtt q2-3h in affected eye while awake, with less frequent administration at night
Ointment: Apply 0.5-in (1.25-cm) ribbon 1-4 times/d into conjunctival sac

Pediatric

<2 months: Not established
>2 months: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in severely dried eye; ointment may retard corneal epithelial healing; significant percentage of staphylococcal isolates are completely resistant; may sting when applied; do not use in deep ocular infections likely to become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms

Decongestants

Generally have vasoconstricting effects with ability to control pruritus.


Naphazoline 0.1%, (Clear Eyes, AK-Con, Opcon)

OTC drug for temporary relief of pruritus and hyperemia associated with mild allergic conjunctivitis. Has alpha-adrenergic effects in the arterioles of the conjunctiva and nasal mucosa to produce vasoconstriction.

Adult

1-2 gtt q2h prn; not to exceed qid; do not administer for more than 3-5 d

Pediatric

<6 years: Not recommended
>6 years: Administer as in adults

None reported with ophthalmic use; in systemic use, risk of hypertensive reactions increases when used concurrently with tricyclic antidepressants or MAOIs; toxicity increases when used concurrently with anesthetics

Documented hypersensitivity; narrow-angle glaucoma; do not use before a peripheral iridectomy is performed

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may cause rebound congestion; caution in diabetes, hypertension, heart disease, cerebral arteriosclerosis, hyperthyroidism, and asthma


Levocabastine (Livostin)

Most potent topical antihistamine available. Has rapid onset and sustained effect. Can be used as many as 4 times daily or prn.

Adult

1 gtt qid to affected eye

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use in patients wearing soft contact lenses; not for injection

Mast cell stabilizers

Inhibit degranulation of sensitized mast cells following exposure to specific antigens.


Cromolyn 4%, (Intal)

Long-term use by patients with seasonal allergies; not used for short-term treatment. Alomide is a far more potent mast cell stabilizer. Patanol is a combination antihistamine and mast cell stabilizer and is used either bid/tid.

Adult

1-2 gtt q4-6h to each eye; use at regular intervals

Pediatric

<4 years: Not established
>4 years: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use with soft contact lenses in place; may experience a transient stinging or burning sensation after application; caution when withdrawing drug because symptoms may recur

Nonsteroidal anti-inflammatory agents (NSAIDs)

These agents are used for the treatment of allergic conjunctivitis. Although most NSAIDs are used primarily for anti-inflammatory effects, they are effective analgesics and are useful for the relief of mild-to-moderate pruritus. Ketorolac 0.4% has also been shown as effective in treating allergic conjunctivitis.3


Ketorolac 0.5%, (Acular, Toradol)

Approved for temporary relief of pruritus associated with allergic conjunctivitis. Inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors.

Adult

1 gtt qid to affected eye

Pediatric

Not established

Documented hypersensitivity; patients wearing soft contact lenses

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Perform ophthalmologic studies in patients who develop eye complaints during therapy; discontinue therapy if changes are noted; changes may include blurred or diminished vision, corneal deposits and retinal disturbances, scotomata, changes in color vision, and macula degeneration

More on Conjunctivitis

Overview: Conjunctivitis
Differential Diagnoses & Workup: Conjunctivitis
Treatment & Medication: Conjunctivitis
Follow-up: Conjunctivitis
References
[ CLOSE WINDOW ]

References

  1. [Guideline] American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern Guidelines. Conjunctivitis. Sept 2008;[Full Text].

  2. US Food and Drug Administration. FDA News Release: FDA approves besivance to treat bacterial conjunctivitis. May 28, 2009. [Full Text].

  3. Schechter BA. Ketorolac tromethamine 0.4% as a treatment for allergic conjuctivitis. Expert Opin Drug Metab Toxicol. Apr 2008;4(4):507-11. [Medline].

  4. Abelson MB, Heller W, Shapiro AM, Si E, Hsu P, Bowman LM. Clinical Cure of Bacterial Conjunctivitis with Azithromycin 1%: Vehicle-Controlled, Double-Masked Clinical Trial. Am J Ophthalmol. Mar 27 2008;[Medline].

  5. Alessandrini EA. The case of the red eye. Pediatr Ann. Feb 2000;29(2):112-6. [Medline].

  6. Bersudsky V, Rehany U, Tendler Y. Diagnosis of chlamydial infection by direct enzyme-linked immunoassay and polymerase chain reaction in patients with acute follicular conjunctivitis. Graefes Arch Clin Exp Ophthalmol. Aug 1999;237(8):617-20. [Medline].

  7. Bertolini J, Pelucio M. The red eye. Emerg Med Clin North Am. Aug 1995;13(3):561-79. [Medline].

  8. Bessman ES. Nontraumatic eye disorders. In: Howell J, ed. Emergency Medicine. WB Saunders; 1997:609-625.

  9. Blumenthal MN, Schwartz RH, Kaiser H. Nedocromil sodium 2% ophthalmic solution for the treatment of ragweed pollen seasonal allergic conjunctivitis. Ocul Immunol Inflamm. Sep 2000;8(3):159-67. [Medline].

  10. Brook I. Ocular infections due to anaerobic bacteria in children. J Pediatr Ophthalmol Strabismus. Mar-Apr 2008;45(2):78-84. [Medline].

  11. Chisari G, Reibaldi M. Ciprofloxacin as treatment for conjunctivitis. J Chemother. Apr 2004;16(2):156-9. [Medline].

  12. Cochereau I, Meddeb-Ouertani A, Khairallah M, Amraoui A, Zaghloul K, Pop M, et al. 3-day treatment with azithromycin 1.5% eye drops versus 7-day treatment with tobramycin 0.3% for purulent bacterial conjunctivitis: multicentre, randomised and controlled trial in adults and children. Br J Ophthalmol. Apr 2007;91(4):465-9. [Medline].

  13. de Toledo AR, Chandler JW. Conjunctivitis of the newborn. Infect Dis Clin North Am. Dec 1992;6(4):807-13. [Medline].

  14. Fitch CP, Rapoza PA, Owens S. Epidemiology and diagnosis of acute conjunctivitis at an inner-city hospital. Ophthalmology. Aug 1989;96(8):1215-20. [Medline].

  15. Friedlaender MH. The current and future therapy of allergic conjunctivitis. Curr Opin Ophthalmol. Aug 1998;9(4):54-8. [Medline].

  16. Friedlaender MH, Howes J. A double-masked, placebo-controlled evaluation of the efficacy and safety of loteprednol etabonate in the treatment of giant papillary conjunctivitis. The Loteprednol Etabonate Giant Papillary Conjunctivitis Study Group I. Am J Ophthalmol. Apr 1997;123(4):455-64. [Medline].

  17. Gallenga PE, Lobefalo L, Colangelo L. Topical lomefloxacin 0.3% twice daily versus tobramycin 0.3% in acute bacterial conjunctivitis: A multicenter double-blind phase III study. Ophthalmologica. 1999;213(4):250-7. [Medline].

  18. Hammerschlag MR, Gelling M, Roblin PM. Treatment of neonatal chlamydial conjunctivitis with azithromycin. Pediatr Infect Dis J. Nov 1998;17(11):1049-50. [Medline].

  19. Joss JD, Craig TJ, R. Seasonal allergic conjunctivitis: overview and treatment update. J Am Osteopath Assoc. Jul 1999;99(7 Suppl):S13-8. [Medline].

  20. Kruse A, Thomsen RW, Hundborg HH. Diabetes and risk of acute infectious conjunctivitis--a population-based case-control study. Diabet Med. Apr 2006;23(4):393-7. [Medline].

  21. Leonardi A, Zafirakis P. Efficacy and comfort of olopatadine versus ketotifen ophthalmic solutions: a double-masked, environmental study of patient preference. Curr Med Res Opin. Aug 2004;20(8):1167-73. [Medline].

  22. Limberg MB. A review of bacterial keratitis and bacterial conjunctivitis. Am J Ophthalmol. Oct 1991;112(4 Suppl):2S-9S. [Medline].

  23. Litoff D, Belin MW, Catalano RA. Ocular infections and inflammation. In: Ocular Emergencies. Philadelphia: WB Saunders Co:1992:461-495. [Medline].

  24. Marangon FB, Miller D, Muallem MS, et al. Ciprofloxacin and levofloxacin resistance among methicillin-sensitive Staphylococcus aureus isolates from keratitis and conjunctivitis. Am J Ophthalmol. Mar 2004;137(3):453-8. [Medline].

  25. Morden NE, Berke EM. Topical fluoroquinolones for eye and ear. Am Fam Physician. Oct 15 2000;62(8):1870-6. [Medline].

  26. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician. Feb 15 1998;57(4):735-46. [Medline].

  27. Newell FW. Conjunctivitis and keratitis. In: Ophthalmology: Principles and Concepts. St Louis: Mosby; 1992:225-245.

  28. Nichols J, Snyder RW. Topical nonsteroidal anti-inflammatory agents in ophthalmology. Curr Opin Ophthalmol. Aug 1998;9(4):40-4. [Medline].

  29. Porazinski AD, Donshik PC. Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study. CLAO J. Jul 1999;25(3):142-7. [Medline].

  30. Rose GE. The giant fornix syndrome: an unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis. Ophthalmology. Aug 2004;111(8):1539-45. [Medline].

  31. [Best Evidence] Sheikh A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2006;CD001211. [Medline].

  32. Steinert RF. Current therapy for bacterial keratitis and bacterial conjunctivitis. Am J Ophthalmol. Oct 1991;112(4 Suppl):10S-14S. [Medline].

  33. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Apr 2006;119(4):302-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.