TABLE I MAIN CLINICAL DIAGNOSTIC GUIDELINES
TABLE II MAIN DIAGNOSTIC GUIDELINES
Main causing factor
Main ocular manifestations
Usually Strepto- cocci and Sta- phylococci, less frequently Haemophilus (children) and enteric gram- negative orga- nisms
5 – 7 days
Sticky purulent discharge, moderate conjunctival hyperaemia, crustings on the eyelids and/or lashes, lids sticking in the morning upon waking due to puru- lent discharge. Corneal involvement is very uncommon.
Often caused by Neisseria species (N. gonorrhoeae, meningitides) less often by other bacteria e.g. Pseudomonas aeruginosa
Develops usually in new- borns and less often in adult patient. Bilateral, severe, fulminating conjunctivitis with profuse lid and con- junctival oedema, very copious, yellow-green, purulent discharge. There is a high risk of corneal infil- tration and corneal perfora- tion within hours. Can lead to blindness.
In neonates, septicae- mia with arthritis and meningitis may deve- lop. In adults, septi- caemia with arthritis and pelvic inflamma- tory disease (rarely). Examine the patient and his/her sexual partner (venereal disease).
Usually adeno- viruses, herpes simplex viruses, less frequently varicella-zoster viruses, picorna- viruses, molu- scum contagio- sum, or pox and papilloma viru- ses
2 – 3 weeks
Significant conjunctival hyperaemia, copious, clear, watery, serous discharge, eyelid oedema, follicular conjunctival reaction, sub- and conjunctival haemor- rhages (picornaviruses). Typical vesicular eyelid rash in herpes simplex and vesi- cular skin eruptions in zoster, umbilical eyelid lesions in molluscum infec- tions, verrucae in papilloma virus infection. Often cor- neal involvement (keratitis). Very contagious.
Frequent history of recent fever, upper respiratory tract infections or pharyn- gitis. Enlarged preau- ricular lymph nodes, adenopathia.
Chlamydia tra- chomatis, psit- taci and pneu- moniae
More than 3 weeks with exa- cerbations and remis- sions
Mucopurulent discharge, moderate hyperaemia, folli- cular conjunctival reaction, pseudoptosis. Often corneal involvement (keratitis and pannus). Corneal changes and con- junctival cicatrization the most frequent in trachoma.
Pneumonia and otitis (in children), cervicitis and/or vaginitis (in women), symptoma- tic or non-symptoma- tic urethritis (in men), enlarged preauricular lymph nodes. Examine the patient and his/her sexual part- ner (venereal disease).
TABLE III INTERPRETATION OF CONJUNCTIVAL CYTOLOGY RESULTS IN DIFFERENT TYPES OF CONJUNCTIVITIS
Diagnosed on the basis of medical history and eye exa- mination. Diagnostic tests are indicated in neonatal bac- terial conjunctivitis, difficult clinical cases, recurrent con- junctivitis and in patients not responding to medication.
It is mandatory to perform slide stains, cultures and anti- biotic sensitivity as a matter of urgency.
Diagnosed on the basis of medical history and eye exa- mination. Tests (viral cultures and immunodiagnostic) are not very helpful but can be performed in diagnosti- cally difficult cases only.
If diagnosis can not been made on a clinical basis per- formance of cytology (Halberstaedter – von Provazek bodies), direct immunofluorescent antibody test, ELISA and PCR tests of ocular specimens may be helpful.
Mononuclear cells (lymphocytes and monocytes)
Polymorphonuclear leucocytes, monocytes and perinu- clear inclusions (Halberstaedter – von Provazek bodies)
Eosinophils and basophils
Polymorphonuclear leucocytes and giant cells with orga- nisms
Type of conjunctivitis
Suggested diagnostic tests
Type of conjunctivitis
Cytology of the conjunctival smear