Photophobia requires keratitis or uveitis exclusion
Geriatric
Geriatric considerations
Baseline ocular disease prevalence
Dry eye disease common mimic
Blepharitis contribution common
Higher stakes for vision changes
Glaucoma risk
Herpetic eye disease recurrence risk
Medication tolerability
Preservative irritation risk
Prefer preservative-free lubricants when frequent dosing
Pediatrics
Pediatric considerations
Etiology distribution
Viral common in school outbreaks
Allergic common with atopy
School and daycare considerations
Symptom-based return guidance
Hygiene reinforcement
Topical dosing practicality
Ointment easier administration for younger children
Drop technique coaching for caregivers
Neonatal conjunctivitis
Day 0 to 2 onset pattern
Chemical conjunctivitis possible
Supportive care after exclusion of infection
Day 2 to 5 onset pattern
Gonococcal concern
Ceftriaxone pathway and admission consideration
Day 5 to 14 onset pattern
Chlamydial concern
Systemic macrolide therapy pathway
Background
Epidemiology
Epidemiology overview
Viral conjunctivitis
Most common infectious conjunctivitis overall
Adenovirus common cause
Bacterial conjunctivitis
More common in children than adults
Self-limited course common
Allergic conjunctivitis
Seasonal prevalence in atopic patients
Often recurrent pattern
Pathophysiology
Mechanisms
Viral
Conjunctival epithelial infection
Follicular response and watery discharge
Bacterial
Neutrophilic inflammation
Mucopurulent discharge and crusting
Allergic
IgE mediated mast cell activation
Histamine driven itch and chemosis
Contact lens risk
Microtrauma to epithelium
Pseudomonas keratitis risk
Therapeutic Considerations
Rationale and tradeoffs
Antibiotics
Benefit greatest in moderate to severe purulence
Reduced symptom duration in some trials
Resistance pressure with unnecessary use
Fluoroquinolones
Pseudomonas coverage for contact lens risk
Reserve for higher-risk presentations
Antihistamine mast cell stabilizers
Rapid itch relief
Prevention with regular use during season
Steroids
Avoid without ophthalmology in infectious presentations
Intraocular pressure rise risk
Patient Discharge Instructions
copy discharge instructions
Discharge instructions
Diagnosis explanation
Conjunctivitis types include viral, bacterial, allergic
Most cases improve with supportive care
Medication use
Drops and ointment technique
Complete prescribed course if antibiotics started
Contact lens guidance
No contact lenses until symptoms fully resolved
Replace lenses and case after infection
Hygiene
Hand washing after touching eyes
Do not share towels, pillows, or eye makeup
Replace eye makeup after infection
Symptom control
Cool compresses
Artificial tears as needed
Return to ED now
Vision worse
Moderate or severe eye pain
Light sensitivity
New severe headache, vomiting, or halos around lights
Swelling around eye with pain on eye movement
Contact lens wearer with pain or worsening redness
Follow-up
If not improving in 48 to 72 hours
Earlier follow-up for contact lens wearers
References
Guidelines and evidence sources
Core references
American Academy of Ophthalmology conjunctivitis guidance and preferred practice patterns
Hygiene and supportive care for viral conjunctivitis
Steroid avoidance without specialist evaluation for suspected infection
Systematic reviews of topical antibiotics for acute bacterial conjunctivitis
Modest reduction in time to clinical cure
High spontaneous resolution rates
STI guidelines for gonococcal and chlamydial conjunctivitis treatment
Ceftriaxone systemic therapy for gonococcal infection
Systemic therapy for chlamydial infection
Emergency medicine consensus recommendations
Imaging and admission criteria for orbital cellulitis concern
Contact lens wear as keratitis risk trigger
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.