Conjuntivitis

Feature	Bacterial Conjunctivitis	Viral Conjunctivitis	Chlamydial Conjunctivitis	Allergic Conjunctivitis
Follicles/Papillae	Papillae (inflammatory response)	Follicles (indicative of viral etiology)	Follicles (in chronic/severe cases)	Papillae ("cobblestone" in chronic cases)
Itching	Less common	Less itchy	Not prominent	Hallmark symptom, often severe
Tearing	Mild tearing	Watery discharge	Mild to moderate tearing	Increased tearing
Discharge	Purulent (yellow/green)	Watery to slightly mucous	Mucopurulent	Watery or stringy mucus
Associated Symptoms	Mild sore throat or fever (occasionally)	Swollen preauricular lymph nodes, fever, sore throat	May involve cornea, lead to scarring; fever, sore throat	Sneezing, nasal congestion, runny nose
Treatment	Antibiotic eye drops/ointments (e.g., erythromycin, polymyxin B-trimethoprim, fluoroquinolones)	Supportive care (cool compresses, artificial tears); Antiviral medications for herpes (e.g., acyclovir, valacyclovir)	Systemic antibiotics (azithromycin, doxycycline); Eye hygiene; Partner treatment	Antihistamine/Mast Cell Stabilizer eye drops (e.g., olopatadine); Avoid allergens; Cool compresses; Oral antihistamines; Corticosteroid eye drops (severe cases)
Hygiene/Precautions	Good eye hygiene; Avoid touching eyes; Frequent hand washing	Good hygiene; Avoid sharing towels/cosmetics; Isolation precautions	Good eye hygiene; Prevent spread and reinfection	Identify and avoid triggers

Image credit: "Conjunctiva Reaction: Papillae & Follicles" sourced from Adult & Child Eye Care - adultchildeye.com Bacterial Conjunctivitis

• Follicles/Papillae: More likely to have papillae due to the inflammatory response to bacterial infection.

• Itching: Less common compared to allergic conjunctivitis.

• Tearing: Mild tearing may be present.

• Discharge: Purulent (pus-like) discharge, often yellow or green, causing eyelids to stick together, especially upon waking.

• Associated Symptoms: May occasionally have mild sore throat or fever in severe infections or systemic involvement.

• Antibiotic Therapy: Topical antibiotic eye drops or ointments are the mainstay of treatment. Common choices include erythromycin ointment or antibiotic drops like polymyxin B-trimethoprim. For more severe infections, fluoroquinolones (e.g., ofloxacin, moxifloxacin) can be used.

• Hygiene: Patients should be advised to maintain good eye hygiene, avoid touching their eyes, and wash their hands frequently to prevent spreading the infection.

• Warm Compresses: Applying warm compresses to the eyes can help relieve discomfort and remove crusts.
  

Viral Conjunctivitis

• Follicles/Papillae: Follicles are characteristic, especially on the inner eyelids, indicating viral etiology.

• Itching: Less itchy compared to allergic conjunctivitis.

• Tearing: Watery discharge is more common.

• Discharge: Watery to slightly mucous discharge.

• Associated Symptoms: Swollen preauricular lymph nodes, fever, and sore throat can accompany the conjunctivitis, especially with adenoviral infections.

• Supportive Care: Since most viral conjunctivitis is self-limiting, treatment focuses on relieving symptoms. Cool compresses, lubricating eye drops (artificial tears), and maintaining good hygiene are recommended.

• Antiviral Medications: In cases caused by the herpes simplex virus, topical or oral antiviral medications, such as acyclovir or valacyclovir, are necessary.

• Isolation Precautions: Patients should be educated on minimizing the spread of the virus, including avoiding sharing towels, cosmetics, or eye drops.
  

Chlamydial Conjunctivitis

• Follicles/Papillae: Follicles can be present, especially in chronic or severe cases.

• Itching: Itching is not a prominent symptom.

• Tearing: Mild to moderate tearing.

• Discharge: Mucopurulent discharge is characteristic.

• Associated Symptoms: May involve the cornea and lead to scarring; often associated with systemic symptoms such as fever and sore throat in inclusion conjunctivitis.

• Systemic Antibiotics: Requires oral antibiotics due to the systemic nature of the infection. Azithromycin (single dose) or a week-long course of doxycycline is effective. Erythromycin can be an alternative, especially for pregnant women.

• Partner Treatment: Sexual partners should also be treated to prevent reinfection and control the spread of chlamydia.

• Eye Hygiene: Similar to bacterial conjunctivitis, maintaining eye hygiene is crucial to prevent spread and reinfection.
  

Allergic Conjunctivitis

• Follicles/Papillae: Papillae are common, especially "cobblestone" papillae under the upper eyelid in chronic cases.

• Itching: Itching is a hallmark symptom, often severe.

• Tearing: Increased tearing is a common response to allergen exposure.

• Discharge: Usually watery or stringy mucus.

• Associated Symptoms: Often accompanied by other allergic symptoms such as sneezing, nasal congestion, or a runny nose. Fever and sore throat are not typical unless there is concurrent allergic rhinitis.

• Antihistamine/Mast Cell Stabilizer Eye Drops: These medications, such as olopatadine, can provide quick relief from itching and redness.

• Avoid Allergens: Identifying and avoiding triggers is a key component of managing allergic conjunctivitis.

• Cool Compresses: Can help alleviate itching and swelling.

• Oral Antihistamines: May be helpful, especially if the patient is experiencing other systemic allergic symptoms. However, they can sometimes cause dry eyes.

• Corticosteroid Eye Drops: Used for severe cases under close supervision due to potential side effects, including increased intraocular pressure and cataract formation.