Conjunctivitis Diagnosis and Treatment

Clinical Presentation

The American Academy of Ophthalmology recommends that conjunctivitis viral is self-limiting and requires mainly supportive measures and strict hygiene, while conjunctivitis bacterial in adults usually resolves spontaneously but can be treated with topical antibiotics, being critical to identify cases that require urgent treatment such as gonococcal conjunctivitis which can cause corneal perforation in 24-48 hours 1, 2
Conjunctivitis viral is characterized by watery discharge with bulbar conjunctival injection, often bilateral, and follicular reaction in the lower tarsal conjunctiva 3, 1
Adenopathy is frequently present in viral conjunctivitis 3, 1
Recent exposure to an infected individual, especially in a school setting, is a common context for viral conjunctivitis 3
Upper respiratory infections are often concurrent in cases of pharyngoconjunctival fever 2

Bacterial conjunctivitis is characterized by purulent or mucopurulent discharge, often with stuck eyelids upon waking, and bulbar conjunctival injection, which can be unilateral or bilateral 3, 4
The absence of prominent follicles distinguishes bacterial from viral conjunctivitis 3

Gonococcal conjunctivitis is an ophthalmological emergency characterized by marked eyelid edema, severe hyperpurulent discharge, and corneal infiltrate or ulceration that can progress to perforation in 24-48 hours 3, 4, 2
In neonates, gonococcal conjunctivitis manifests 1-7 days post-partum and carries a risk of septicemia, arthritis, meningitis, and death 5, 2
In adults, it presents as rapidly developing severe hyperpurulent conjunctivitis, associated with urethritis and pelvic inflammatory disease 3, 4

The American Academy of Ophthalmology suggests examining the cornea with fluorescein staining in any case of purulent conjunctivitis to detect early corneal involvement 2
Evaluating the presence of follicles in the lower tarsal conjunctiva (suggestive of viral etiology) and searching for membranes/pseudomembranes (associated with severe adenoviral infection and higher risk of sequelae) are crucial 3, 2
Palpation of preauricular lymph nodes (more common in viral conjunctivitis) is also important 3, 1

For viral conjunctivitis, supportive measures such as artificial tears, cold compresses, and topical antihistamines are recommended for symptomatic relief, with improvement of symptoms expected in 5-14 days 3, 7
The use of topical antibiotics is not recommended for viral conjunctivitis as it does not respond to antibacterial agents 8
For bacterial conjunctivitis, moxifloxacino 0.5% three times a day for 4 days is a recommended treatment, with a clinical cure rate of 66-69% by day 5-6 8
Gonococcal conjunctivitis requires urgent treatment with systemic and topical antibiotics 2

Vaccination against herpes zoster is strongly recommended in patients ≥50 years old 8
Screening and treatment of pregnant women to prevent perinatal transmission of gonorrhea and chlamydia are essential 2
Proper disinfection of tonometers, such as using diluted sodium hypochlorite solution (bleach) 1:10, is effective 8