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  • Conjunctivitis PPP 2023

    AAO PPP Cornea/External Disease Committee, Hoskins Center for Quality Eye Care
    Cornea/External Disease
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    By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Albert Y Cheung, MD,1 Daniel S. Choi, MD,2 Sumayya Ahmad, MD, Methodologist,3 Guillermo Amescua, MD,4 Vishal Jhanji, MD, FRCS, FRCOphth,5 Amy Lin, MD,6 Shahzad I. Mian, MD,7 Michelle K. Rhee, MD,8 Elizabeth T. Viriya, MD,9 Francis S. Mah, MD, Co-Chair,10 Divya M. Varu, MD, Co-Chair11

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    1Virginia Eye Consultants, Norfolk, Virginia, Assistant Professor, Department of Ophthalmology, Eastern Virginia Medical School
    2Cataract and Vision Center of Hawaii, Honolulu, Hawaii
    3Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
    4Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
    5Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    6John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
    7Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
    8Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Mount Sinai Services, Elmhurst, New York
    9Department of Ophthalmology, Lincoln Hospital/NYC Health+ Hospitals, Bronx, New York
    10Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California
    11Dell Laser Consultants, Austin, Texas 

    Highlighted Findings and Recommendations for Care



    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 carcinoma, lymphoma, or squamous cell carcinoma; or an underlying inflammatory condition, such as mucous membrane pemphigoid; or a chronic infection such as chlamydia.

    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, to use a separate towel and pillow, and to avoid close contact with others during the period of contagion, which is usually 10 to 14 days from onset.

    Tonometers that are inadequately disinfected can transmit infection. Dilute bleach soak (sodium hypochlorite) at 1:10 concentration is an effective disinfectant for tonometers. 70% isopropyl alcohol (e.g., alcohol wipes), 3% hydrogen peroxide, and ethyl alcohol are no longer recommended. Tonometers that utilize single-use disposable tips can circumvent the issue of sterilization.

    Indiscriminate use of topical antibiotics or corticosteroids should be avoided. Viral conjunctivitis will not respond to antibacterial agents, and mild bacterial conjunctivitis is likely to be self-limited. For acute exacerbations of vernal conjunctivitis, topical corticosteroids are usually necessary to control severe symptoms and sings. No evidence exists demonstrating the superiority of any topical antibiotic agent. 

    Gonococcal conjunctivitis is a hyperacute, vision-threatening infectious condition that requires immediate systemic therapy. Single-use tubes of ophthalmic ointment containing 0.5% erythromycin are used as the standard prophylactic agent to prevent ophthalmia neonatorum.

    Conjunctivitis can be associated with systemic diseases. Diagnosis of superior limbic keratoconjunctivitis may lead to further investigations that reveal a thyroid disorder. Diagnosis of floppy eyelid syndrome should prompt a sleep study to rule out sleep apnea.

    Herpes zoster can cause conjunctivitis, keratitis, and ocular inflammation in multiple tissues of the eye. Herpes zoster vaccination is strongly recommended in patients 50 years or older and patients 19 years or older who are immunocompromised.

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    Conjunctivitis PPP - 2023 - Literature Search