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  • AAO PPP Cornea/External Disease Committee, Hoskins Center for Quality Eye Care
    Cornea/External Disease
    Compendium Type: I

    By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Divya M. Varu, MD,1 Michelle K. Rhee, MD,2 Esen K. Akpek, MD,3 Guillermo Amescua, MD,4 Marjan Farid, MD,5 Francisco J. Garcia-Ferrer, MD,6 Amy Lin, MD7 David C. Musch, PhD, MPH,8 Francis S. Mah, MD,9 Steven P. Dunn, MD10

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

    1 Dell Laser Consultants, Austin, Texas
    2 Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
    3 The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
    4 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
    5 Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
    6 Mercy Clinic Eye Specialists, St. Louis, Missouri
    John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
    Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
    Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California
    10 Michigan Cornea Consultants, P.C., Southfield, Michigan


    Conjunctivitis rarely causes permanent visual loss or structural damage, but the economic impact of conjunctivitis is considerable and largely due to lost work or school time and the cost of medical visits, testing and treatment.

    Chronic and/or recalcitrant conjunctivitis may be indicative of an underlying malignancy, such as sebaceous or squamous cell carcinoma.

    The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently and use separate towels, and to avoid close contact with others during the period of contagion.

    Dilute bleach soak (sodium hypochlorite) at 1:10 concentration is an effective disinfectant for tonometers. Notably, 70% isopropyl alcohol (e.g., alcohol wipes), 3% hydrogen peroxide, and ethyl alcohol are no longer recommended for tonometer disinfection.

    Surfaces should be disinfected with an EPA-registered hospital disinfectant in accordance with the directions and safety precautions on the label.

    Indiscriminate use of topical antibiotics or corticosteroids should be avoided. Viral conjunctivitis will not respond to anti-bacterial agents, and mild bacterial conjunctivitis is likely to be self-limited. No evidence exists demonstrating the superiority of any topical antibiotic agent. [I+, Good, Strong]

     In adults, conjunctivitis caused by ocular mucous membrane pemphigoid (OMMP), graft-versus-host disease (GVHD), gonococcus, and chlamydia are important to detect early because it is necessary to treat the concomitant systemic disorder. Diagnosis of superior limbic keratoconjunctivitis (SLK) may lead to further investigations that reveal a thyroid disorder. Early detection of conjunctivitis associated with neoplasms may be lifesaving.

     Herpes Zoster vaccination should be strongly recommended in patients 50 years or older.

    Literature Search

     Conjunctivitis PPP - 2018 - Literature Search.pdf