Chapter 5: Conjunctiva & Tears

Bacterial

 Hyperacute (purulent)

  Neisseria gonorrhoeae

  Neisseria gonorrhoeae subspecies kochii

  Neisseria meningitidis

 Acute (mucopurulent)

  Pneumococcus (Streptococcus pneumoniae) (temperate climates)

  Haemophilus aegyptius (Koch-Weeks bacillus) (tropical climates)

 Subacute

  Haemophilus influenzae (temperate climates)

 Chronic, including blepharoconjunctivitis

  Staphylococcus aureus

  Moraxella lacunata (diplobacillus of Morax-Axenfeld)

 Rare types (acute, subacute, chronic)

  Streptococci

  Moraxella catarrhalis

  Coliforms

  Proteus

  Corynebacterium diphtheriae

  Mycobacterium tuberculosis

Chlamydial

 Trachoma (Chlamydia trachomatis serovars A–C)

 Inclusion conjunctivitis (C trachomatis serovars D–K)

 Lymphogranuloma venereum (LGV) (C trachomatis serovars L1–3)

Viral

 Acute viral follicular conjunctivitis

  Pharyngoconjunctival fever due to adenoviruses types 3 and 7 and other serotypes

  Epidemic keratoconjunctivitis due to adenovirus types 8 and 19

  Herpes simplex virus

  Acute hemorrhagic conjunctivitis due to enterovirus type 70; rarely, coxsackievirus type A24

 Chronic viral follicular conjunctivitis

  Molluscum contagiosum virus

 Viral blepharoconjunctivitis

  Varicella, herpes zoster due to varicella-zoster virus

  Measles virus

Rickettsial (rare)

 Nonpurulent conjunctivitis with hyperemia and minimal in filtration, often a feature of rickettsial diseases

  Typhus

  Murine typhus

  Scrub typhus

  Rocky Mountain spotted fever

  Mediterranean fever

  Q fever

Fungal (rare)

 Ulcerative or granulomatous

  Candida

 Granulomatous

 Rhinosporidium seeberi

 Coccidioides immitis (San Joaquin Valley fever)

 Sporothrix schenckii

Parasitic (rare but important)

 Chronic conjunctivitis and blepharoconjunctivitis

  Thelazia californiensis

  Loa loa

  Ascaris lumbricoides

  Trichinella spiralis

  Schistosoma haematobium (bladder fluke)

  Taenia solium (cysticercus)

  Phthirus pubis (Pediculus pubis, public louse)

Fly larvae (Oestrus ovis, etc) (ocular myiasis)

Immunologic (allergic)

 Immediate (humoral) hypersensitivity reactions

  Hay fever conjunctivitis (pollens, grasses, animal danders, etc)

  Vernal keratoconjunctivitis

  Atopic keratoconjunctivitis

  Giant papillary conjunctivitis

 Delayed (cellular) hypersensitivity reactions

  Phlyctenulosis

  Mild conjunctivitis secondary to contact blepharitis

 Autoimmune disease

  Primary and secondary Sjögren syndrome

  Mucous membrane pemphigoid

Chemical or irritative

 Iatrogenic

  Idoxuridine, brimonidine, apraclonidine, dipivefrin, and other topically applied drugs

  Preservatives in eye drops

  Contact lens solutions, particularly their preservatives

 Occupational

  Acids

  Alkalies

  Smoke

  Wind

  Ultraviolet light

 Caterpillar hair

Etiology unknown

 Folliculosis

 Chronic follicular conjunctivitis (orphan’s conjunctivitis, Axenfeld conjunctivitis)

 Ocular rosacea

 Psoriasis

 Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme

 Dermatitis herpetiformis

 Epidermolysis bullosa

 Superior limbic keratoconjunctivitis

 Ligneous conjunctivitis

 Reiter syndrome

 Mucocutaneous lymph node syndrome (Kawasaki disease)

Associated with systemic disease

 Graves ophthalmopathy (exposure, congestive)

 Gouty

 Carcinoid

 Sarcoidosis

 Tuberculosis

 Syphilis

Secondary to dacryocystitis ...