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STELLA WINTERS, MD, WINFRED FRAZIER, MD, MPH, AND JACOB WINTERS, MD

Am Fam Physician. 2024;110(2):134-144

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Conjunctivitis caused by viruses, bacteria, or allergies is one of the most common eye conditions in primary care. There is no single sign or symptom that accurately differentiates viral from bacterial conjunctivitis. A comprehensive history and physical examination can guide diagnosis. Viral and allergic conjunctivitis are more common in adults and typically present with watery discharge. Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops. Strict personal hygiene, including frequent handwashing, is essential to decrease the risk of transmission. Topical antihistamines with mast cell–stabilizing activity are the treatment of choice for allergic conjunctivitis. Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut. Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing. Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state.

Conjunctivitis is inflammation of the conjunctiva, which is a clear, vascularized membrane that covers the outer surface of the eye (except the cornea) and the inner surface of the eyelids1,2 (Figure 1). Data from nearly 12 million eye-related emergency room visits found that 44% were for nonemergent causes with conjunctivitis being the most common reason.3 There are significant direct costs (i.e., copays and prescriptions) and indirect costs (i.e., work or school absenteeism) associated with conjunctivitis, accounting for an estimated $1 billion annually in the United States alone.4–6 The most common etiologies of conjunctivitis are allergic, viral, and bacterial.2,7 Conjunctivitis is usually self-limited, but complications leading to decreased vision can occur. This article discusses the three most common causes of conjunctivitis, clinical features that can be used to differentiate them, and recommendations for treatment. Table 1 summarizes conjunctivitis treatment options.2,8–14

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