Conjunctivitis: Systematic Approach to Diagnosis and Therapy

Conjunctivitis is a common problem in primary health care. Inflammation of the conjunctiva may result from infection or noninfectious causes. Microbial conjunctivitis may be caused by bacteria, viruses, or parasites. Although usually a benign, self-limited disease in healthy individuals, serious complications (eg, keratitis) may be sight-threatening. Accurate diagnosis and specific treatment of conjunctivitis remain challenging. History taking and physical examination are occasionally insufficient for correct diagnosis, thus laboratory testing may play a vital role in identification of specific pathogen(s). However, diagnostic testing has several limitations, including time-consuming methods, increased cost, and requirement for expertise in performance and interpretation. Treatment with empirical topical antibiotics for suspected infectious conjunctivitis is controversial. Although antibiotic treatment can diminish risk of adverse events and shorten the course of disease, drug resistance, toxicity, and expense are important considerations in management of acute infectious conjunctivitis.