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PubMed1999

Diagnosis of chlamydial infection by direct enzyme-linked immunoassay and polymerase chain reaction in patients with acute follicular conjunctivitis.

BACKGROUND: Acute follicular conjunctivitis is a clinical diagnosis common to multiple etiologies, of which chlamydial infection requires specific antibiotic treatment. PURPOSE: This prospective study was designed to evaluate Chlamydia trachomatis as the cause of acute follicular conjunctivitis by two sensitive tests: direct enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). METHODS: Conjunctival scrapings from patients presented with untreated acute follicular conjunctivitis were examined by ELISA and PCR, and patients were followed up for prolongation of the disease course. RESULTS: All 36 consecutive patients presented with acute follicular conjunctivitis were negative for Chlamydia trachomatis by ELISA and PCR. None of the patients had a prolonged course of more than 4 weeks or required treatment with systemic antibiotics as would be expected from chlamydial infection. CONCLUSIONS: Chlamydia trachomatis was probably not responsible for the acute follicular conjunctivitis in this series, and ELISA and PCR may not be cost effective for evaluation of acute follicular conjunctivitis due to chlamydial infection. Further evaluation of the cost effectiveness of these tests is required in chronic follicular conjunctivitis.

Acute Disease↗
PubMed1981

Etiology of acute conjunctivitis in children.

To determine the etiology of acute conjunctivitis in children seen in pediatric practice, 99 patients with conjunctivitis and 102 age-and season-matched controls were cultured for aerobic bacteria including Haemophilus influenzae, and for viruses, Chlamydia trachomatis, and mycoplasmas. Agents statistically associated with conjunctivitis included H. influenzae (42% vs 0%), Streptococcus pneumoniae (12% vs 3%), and adenoviruses (20% vs 0%). One of these three etiologic agents was isolated from 71 (72%) of the patients. Simultaneous infection with two pathogens was uncommon. Staphylococcus aureus was equally prevalent in diseased and control eyes; one strain of C. trachomatis was isolated from a control eye. Although there were variations in the clinical features of viral and bacterial conjunctivitis, differentiation in an individual patient was difficult. An adenovirus was isolated from 11 (65%) of 17 patients who had pharyngitis in addition to conjunctivitis. H. influenzae was isolated from 14 (74%) of 19 children who had both otitis and conjunctivitis. Adenovirus conjunctivitis was common in the fall and H. influenzae in winter.

Acute Disease↗
PubMed1992

Conjunctival hyperresponsiveness to ocular histamine challenge in patients with vernal conjunctivitis.

We compared the conjunctival responsiveness to histamine diphosphate in patients with vernal conjunctivitis and in healthy control subjects. Fourteen asymptomatic patients with vernal conjunctivitis and 10 healthy volunteers were challenged in one eye with 10 microliters of increasing doses (0.01, 0.05, 0.5, and 1 mg/ml in phosphate-buffered saline) of histamine diphosphate. The contralateral eye was challenged with the diluent only. Photographs of each eye were taken for evaluation of conjunctival redness by two masked investigators. Both patients with vernal conjunctivitis and control subjects reacted to histamine with a dose-dependent conjunctival redness 2 to 5 minutes after ocular challenge. Conjunctival redness was more intense in patients with vernal conjunctivitis than in control subjects after ocular challenge with 0.01 and 0.05 mg/ml of histamine diphosphate solution (p less than 0.05). Moreover, the threshold concentration of histamine diphosphate, extrapolated from each individual dose-response curve, was significantly (p less than 0.02) lower in patients with vernal conjunctivitis than in control subjects. Our findings suggest that patients with vernal conjunctivitis demonstrate conjunctival hyperresponsiveness to a nonspecific challenging agent. Nonspecific conjunctival hyperreactivity, a novel concept in allergic eye disease, may be relevant for a better understanding of the pathogenesis and clinical variability of vernal conjunctivitis.

Adolescent↗
PubMed1996

A new murine model of allergic conjunctivitis and effectiveness of nedocromil sodium.

BACKGROUND: Allergic conjunctivitis is the most common atopic disease affecting the eye. To study the pathophysiology and effectiveness of antiallergic drugs, it is necessary to develop animal models that closely mimic human allergic conjunctivitis. OBJECTIVE: The study was performed to develop an experimental murine model of ocular allergic conjunctivitis to an airborne allergen. METHODS: SWR/J mice were divided into the following groups: group 1, untreated, experimental; group 2, phosphate-buffered saline-treated; group 3, nedocromil sodium-treated; and group 4, unmanipulated controls. Groups 1, 2, and 3 were exposed to ragweed by topical contact with the nasal and conjunctival mucosae. Allergic conjunctivitis was evaluated by scoring of clinical signs, serum IgE levels, and histologic findings. RESULTS: Mice exposed to ragweed had clinicopathologic signs of allergic conjunctivitis and specific anti-ragweed IgE. Allergic conjunctivitis was modulated by nedocromil sodium. Treated mice had fewer clinical signs of allergy, lower levels of ragweed-specific IgE, reduction of conjunctival eosinophil infiltration, decrease in the number of intact and degranulating mast cells, and reduction of cytokine release. CONCLUSION: This is the first report of a murine model of allergic conjunctivitis to an airborne allergen that can be used to study the disease pathophysiology and its response to treatment.

Animals↗
PubMed2006

[Clinical study of Supranettes pads in the treatment of seasonal or perennial allergic conjunctivitis in children].

PURPOSE: Ocular allergy is a common disease that is on the rise. Seasonal and perennial conjunctivitis are the most common forms of ocular allergy. Itching, hyperemia, foreign body sensation, irritation, blurred vision or ocular dryness sensations, tearing, and photophobia are the clinical signs observed in patients. A topical antiallergic treatment is prescribed associated with ocular cleaning to contribute to an antigen washing of the ocular surface. Our study aimed to evaluate the use of Supranettes pads as supplementation treatment in children for seasonal or perennial conjunctivitis. MATERIAL AND METHODS: Our prospective study was done in children with a diagnosis of seasonal or perennial clinical ocular allergy. Every symptom was rated from 0 to 4 according to the intensity described by the children and their parents. Twenty children (range, 4-10 years) presenting an ocular allergy were included in the study. A topical antiallergic treatment membrane stabilizer or antihistamine and Supranettes pads were prescribed for ocular cleaning of one randomized selected eye four times a day. Patients were seen in consultation 1 month later to evaluate the treatment. The ocular comfort of each eye, one treated with Supranettes pads and the other not treated by Supranettes pads, was evaluated by the child helped by parents on a graduated self-evaluation scale (range, 0-10). The Mann-Whitney statistical test was used to differentiate the two groups. RESULTS: Of the 20 patients, eleven presented seasonal conjunctivitis and nine perennial conjunctivitis. Six of them presented conjunctivitis with a slight to moderate superficial punctuate keratitis. At the consultation on day 28+/-3, patients who were first treated showed clear improvement of clinical signs with the prescribed treatment. The statistical comparison of the two groups confirmed a significant difference (p<0.05) to the advantage of the group using the Supranettes pads. DISCUSSION: Ocular washing is essential in the treatment of allergic conjunctivitis. The new galenic form of ocular cleaning by physiological serum-impregnated pads is simple to use for children. An objective significant difference is difficult to observe in 1 month. CONCLUSION: This study underlines the importance of the comfort of Supranettes pads evaluated in the treatment of children's conjunctivitis. It confirms the advantage of developing evaluation studies including patient satisfaction and quality of life in ophthalmology.

Bandages↗
PubMed2004

Perilimbal bulbar conjunctival pigmentation in vernal conjunctivitis: prospective evaluation of a new clinical sign in an Indian population.

OBJECTIVES: To prospectively evaluate the occurrence of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis and normal controls; to document the location, extent, density, and color of such pigmentation; and to correlate these changes with disease severity. METHODS: Prospective, noninterventional case-control study. Demographic data, disease symptoms and duration, clinical signs of disease severity and extent, and characteristics of the perilimbal pigmentation were recorded. RESULTS: Twenty-five patients with vernal conjunctivitis and 30 controls were studied. The mean age of the patients (21 M, 4 F) and controls (18 M, 12 F) was 7.5 +/- 3.7 years and 10.3 +/- 3.1 years, respectively. Perilimbal pigmentation was seen in all patients with vernal conjunctivitis and in none of the controls. The palpebral conjunctival changes and patient symptoms correlated with the severity of the disease in patients with vernal conjunctivitis. However, the extent of perilimbal pigmentation did not correlate with the symptoms and signs of vernal conjunctivitis or the density of palisadal pigment. CONCLUSIONS: Perilimbal bulbar conjunctival pigmentation appears to be a consistent finding in patients with vernal conjunctivitis that is both specific and sensitive. It is also present in eyes with inactive disease and hence is a useful clinical sign that aids diagnosis in patients with mild or quiescent disease. Further studies are required to establish the histopathologic correlation of this finding and its etiopathogenesis. It is also important to establish whether this finding occurs with the same frequency in eyes of whites, as this study was performed in a cohort of Asian patients who have greater limbal pigmentation and a higher incidence of limbal changes in vernal conjunctivitis.

Case-Control Studies↗
PubMed2002

Prevalence and onset of rhinitis and conjunctivitis in subjects with occupational asthma caused by trimellitic anhydride (TMA).

Individuals with occupational asthma may also report symptoms of rhinitis or conjunctivitis. The objective of this study was to investigate the prevalence of rhinitis and conjunctivitis in subjects with occupational asthma as a result of trimellitic anhydride (TMA). Additionally, we wanted to evaluate the onset of rhinitis and conjunctivitis symptoms as compared with the occupational asthma symptoms. In a case series design, we studied 25 consecutive employees with TMA-induced asthma; each of them had participated in an annual surveillance program in which they were queried about rhinitis, conjunctivitis, and other respiratory symptoms. Twenty-two of the 25 (88%) reported rhinitis symptoms whereas 17 of the 25 (68%) reported conjunctivitis symptoms. In 17 of the 22 (77%) individuals with rhinitis and asthma, the rhinitis symptoms preceded the asthma symptoms. In 14 of the 17 (82%) individuals with conjunctivitis, those symptoms preceded the asthma symptoms. In summary, symptoms of rhinitis and conjunctivitis are common in subjects with occupational asthma because of TMA and often precede the respiratory symptoms.

Adult↗
PubMed2006

A community outbreak of conjunctivitis caused by nontypeable Streptococcus pneumoniae in Minnesota.

BACKGROUND: The Minnesota Department of Health (MDH) was notified of an outbreak of conjunctivitis in city A with cultures positive for Streptococcus pneumoniae. METHODS: MDH staff contacted clinics and schools in city A and city B regarding conjunctivitis cases, reviewed clinical findings of conjunctivitis cases in city A and collected isolates for subtyping. RESULTS: Between September 1 and December 12, 2003, cities A and B reported 735 conjunctivitis cases. Fifty-one percent of the cases were reported from schools, childcare centers and colleges. Adults were more likely to report itching, burning or swelling of the eye(s); children were more likely to report crusty eyes (P < 0.05). Forty-nine percent of conjunctival cultures (71 of 144) were positive for S. pneumoniae. All isolates were nontypeable by serotyping. Pulsed field gel electrophoresis identified 3 clonal groups with 84% of isolates belonging to one clonal group. Multilocus sequence typing revealed that isolates had the same multilocus sequence type as isolates from a 2002 outbreak at a New England college. CONCLUSIONS: This outbreak was widespread in the community and conjunctivitis clinical presentation varied by age. The predominant strains in this outbreak were related to a pneumococcal strain implicated in prior conjunctivitis outbreaks, suggesting these strains have a predilection for causing conjunctivitis.

Adolescent↗
PubMed1977

A microbiological study of neonatal conjunctivae and conjunctivitis.

To investigate the importance of chlamydiae, ureaplasmas, Mycoplasma hominis, and anaerobic bacteria in the pathogenesis of neonatal conjunctivitis in the Harrow population conjunctival specimens from 104 infants with conjunctivitis and 104 similar healthy neonates were examined. The incidence of neonatal conjunctivitis was 8-2%, and no case of neomycin-resistant disease occurred during the study. Staphylococcus aureus, viridans Streptococci, and Escherichia coli were the only micro-organisms isolated significantly more frequently from affected than from control eyes, which suggests that these bacteria may be a cause of the conjunctivitis. All cultures for chlamydiae, M. hominis, Neisseria gonorrhoeae, and anaerobic bacteria were negative. The mother's race, social status, illness, and obstetric events were found to have no effect on the incidence, time of onset of conjunctivitis, or micro-organisms isolated. The clinical characteristics of conjunctivitis were also not related to the micro-organisms isolated. No potential pathogens were isolated from 63-5% of the eyes showing conjunctivitis. The results suggest that some of these cases may be caused by chemical irritation, and the possibility of an infectious aetiology is also discussed.

Conjunctiva↗
PubMed2005

[Clinical and virological studies of nosocomial conjunctivitis infection caused by adenovirus type 37 variant].

PURPOSE: To study the clinical features and virological analysis of the nosocomial adenoviral conjunctivitis cases occurring in the ophthalmology ward of Fukushima Medical University Hospital. MATERIALS AND METHODS: We studied the symptoms and clinical course of 61 patients who had adenoviral conjunctivitis caused by nosocomial infections in our hospital. We attempted to detect the adenovirus antigen, analyze the viral DNA, and isolate the virus from conjunctival swabs. RESULTS: The clinical symptoms of adenoviral conjunctivitis were mainly conjunctival hyperemia, discharge and conjunctival follicles. Adenoviral conjunctivitis patients who had undergone ophthalmic surgery had conjunctivitis in the operated eye. The sensitivity of Adeno-check was 78.9% in the in-patients. Adenovirus type 37 variant was detected by molecular analysis and viral isolation. CONCLUSIONS: Adenoviral conjunctivitis can often lead to outbreaks of nosocomial infection in the ophthalmic ward and sometimes requires makes necessary restriction of hospitalization and closing of the ward. Therefore, patients need to be observed carefully. The virological analysis of specimens from conjunctival swabs detected pathogens and provided useful information concerning adenoviral conjunctivitis.

Adenoviruses, Human↗
PubMed1990

Conjunctivitis associated with methicillin-resistant Staphylococcus aureus in a long-term-care facility.

PURPOSE: To determine the clinical characteristics of conjunctivitis associated with methicillin-resistant Staphylococcus aureus (MRSA) in a long-term-care facility. PATIENTS AND METHODS: We followed 20 episodes of MRSA-associated conjunctivitis in 19 patients occurring over a three-year period in a 432-bed long-term-care facility. RESULTS: The clinical picture was that of a purulent conjunctivitis from which MRSA was isolated on culture. Seventeen patients had severe, pre-existing neurologic impairment. Nine were colonized by MRSA before the onset of conjunctivitis. Seven of eight patients treated with oral ciprofloxacin and all eight patients treated with topical vancomycin showed clinical resolution of conjunctivitis. Persistence of MRSA colonization at a variety of anatomic sites was noted after therapy following 14 episodes. CONCLUSION: MRSA-associated conjunctivitis in our long-term-care facility was notable for its occurrence in patients with severe neurologic disease. Both oral ciprofloxacin and topical vancomycin therapy were associated with clinical resolution. Since MRSA is endemic in many long-term-care facilities, it is likely that MRSA-associated conjunctivitis will be increasingly recognized.

Adult↗
PubMed1998

Ligneous conjunctivitis in plasminogen-deficient mice.

Ligneous conjunctivitis is a rare form of chronic pseudomembranous conjunctivitis that is associated with systemic membranous pathological changes. A probable link between plasminogen and ligneous conjunctivitis has been indicated by the recent diagnoses of plasminogen deficiency in five patients suffering from ligneous conjunctivitis. The current study reports that plasminogen-deficient mice develop conjunctival lesions indistinguishable from human ligneous conjunctivitis in both appearance and histology. Both human and mouse lesions contain acellular material rich in fibrin, and aberrant or disrupted epithelium. The incidence of lesion development in mice increases with age and is strongly influenced by genetic background. Interestingly, ligneous conjunctivitis was not observed in plasminogen-deficient mice simultaneously lacking fibrinogen. This study provides direct evidence that plasminogen deficiency is one cause of ligneous conjunctivitis and suggests that plasminogen-deficient mice may be an excellent model for the development of therapeutic strategies for the treatment of this debilitating disease.

Aging↗
PubMed1998

Conjunctivitis.

Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. It is the most common cause of "red eye". The etiology can usually be determined by a careful history and an ocular examination, but culture is occasionally necessary to establish the diagnosis or to guide therapy. Conjunctivitis is commonly caused by bacteria and viruses. Neisseria infection should be suspected when severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate three to five days postpartum. Conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is usually self-limited. Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis. Treatment requires good eyelid hygiene and the application of topical antibiotics as determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen exposure. This condition is generally treated with topical antihistamines, mast-cell stabilizers or anti-inflammatory agents.

Acute Disease↗
PubMed1993

Acute conjunctivitis in childhood.

We obtained specimens for culture from the lids and conjunctivae of 95 patients with acute conjunctivitis and 91 control children of similar age and, in addition, stained the conjunctival scrapings with Giemsa and Gram stains. The conjunctivitis was attributed to bacterial infection in 76 patients, viral infection in 12 children, and allergy in 2 patients; no cause was identified in the remaining 5 patients. In most cases the etiologic diagnosis was based on the results of laboratory studies. By separately culturing microorganisms in specimens from the lids and conjunctivae of patients and control subjects, we could distinguish normal flora from pathogens, and blepharitis from conjunctivitis. Staphylococci, corynebacteria, and alpha-hemolytic streptococci were the predominant organisms recovered from the lids of control subjects. In contrast, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were the major pathogens cultured from the conjunctival specimens from patients with bacterial conjunctivitis. Gram stains of conjunctival scrapings provided a rapid means of predicting the pathogen in 51 of 55 cases of bacterial conjunctivitis. Giemsa stains of conjunctival scrapings provided etiologic information in 81 of 84 cases, showing neutrophilia in bacterial infections, lymphocytosis in viral infections, and eosinophilia in allergic disease. These results indicate that most cases of acute conjunctivitis in children can be diagnosed on the basis of differential cultures of microorganisms from the lid and conjunctiva, together with Giemsa stains of conjunctival scrapings.

Acute Disease↗
PubMed2006

Impact assessment and recommendation of alternative conjunctive water use strategies for salt affected agricultural lands through a field scale decision support system - a case study.

Conjunctive use of saline/non-saline irrigation waters is generally aimed at minimizing yield losses and enhancing flexibility of cropping, without much alteration in farming operations. Recommendation of location-specific suitable conjunctive water use plans requires assessment of their long-term impacts on soil salinization/sodification and crop yield reductions. This is conventionally achieved through long-term field experiments. However such impact evaluations are site specific, expensive and time consuming. Appropriate decision support systems (DSS) can be time-efficient and cost-effective means for such long-term impact evaluations. This study demonstrates the application of one such (indigenously developed) DSS for recommending best conjunctive water use plans for a, rice-wheat growing, salt affected farmer's field in Gurgaon district of Haryana (India). Before application, the DSS was extensively validated on several farmers and controlled experimental fields in Gurgaon and Karnal districts of Haryana (India). Validation of DSS showed its potential to give realistic estimates of root zone soil salinity (with R = 0.76-0.94; AMRE = 0.03-0.06; RMSPD = 0.51-0.90); sodicity (with R = 0.99; AMRE = 0.02; RMSPD = 0.84) and relative crop yield reductions (AMRE = 0.24), under existing (local) resource management practices. Long term (10 years) root zone salt build ups and associated rice/wheat crop yield reductions, in a salt affected farmer's field, under varied conjunctive water use scenarios were evaluated with the validated DSS. It was observed that long-term applications of canal (CW) and tube well (TW) waters in a cycle and in 1:1 mixed mode, during Kharif season, predicted higher average root zone salt reductions (2-9%) and lower rice crop yield reductions (4-5%) than the existing practice of 3-CW, 3-TW, 3-CW. Besides this, long-term application of 75% CW mixed with 25% TW, during Rabi season, predicted about 17% lower average root-zone salt reductions than the cyclic applications of (1-CW, 1-TW, 2-CW) and (2-CW, 1-TW, 1-CW, i.e., existing irrigation strategy). However, average wheat crop yield reductions (16-17%) simulated under all these strategies were almost at par. In general, cyclic-conjunctive water use strategies emerged as better options than the blending modes. These results were in complete confirmation with actual long-term conjunctive water use experiments on similar soils. It was thus observed that such pre-validated tools could be efficient means for designing, local resource and target crop yield-specific, appropriate conjunctive water use plans for irrigated agricultural lands.

Agriculture↗
PubMed2005

Why do general practitioners prescribe antibiotics for acute infective conjunctivitis in children? Qualitative interviews with GPs and a questionnaire survey of parents and teachers.

BACKGROUND: Acute infective conjunctivitis in children is a common presentation in primary care. Treatment is usually with antibiotics and prescribing may be affected by non-clinical factors. AIMS: To investigate the non-clinical determinants of the management of acute infective conjunctivitis in children. DESIGN: Qualitative interviews with GPs and a questionnaire survey of parents of children with acute infective conjunctivitis and teachers. SETTING: GPs in Sheffield and Berkshire and parents of children with acute infective conjunctivitis and schools in Oxfordshire. METHODS: Semi-structured telephone interviews of 39 GPs. Questionnaire survey of 326 parents of children enrolled into a trial of acute infective conjunctivitis treatment. Questionnaire survey of 223 nurseries and primary schools in Oxfordshire. RESULTS: All three groups agreed that acute infective conjunctivitis was a mild condition. Parents were certain about the benefits of antibiotic treatment and sought early consultations with their GP in a desire to get their child back to school. GPs sometimes collude with a parent's request to prescribe to enable school attendance. Despite this 54.2% (95%CI 48.5-59.8%) children missed a mean of 1.85 days from school and 28.6% of parents (95%CI 23.5-33.7%) missed a mean of 1.5 days off work. CONCLUSION: Social factors, including the need for children to attend day care or school and parents to go to work, contribute to the decision to prescribe antibiotics for children with acute infective conjunctivitis. Understanding these issues and changing school policies in line with national guidance may reduce pressure on GPs to prescribe for this condition.

Adult↗
PubMed2000

Ligneous conjunctivitis in a girl with severe type I plasminogen deficiency.

BACKGROUND: Ligneous conjunctivitis is a rare form of chronic recurrent pseudomembranous disease and may be associated with systemic membranous pathological changes. Recently ligneous conjunctivitis has been linked to severe type I plasminogen deficiency. We report on a patient with plasminogen deficiency and severe bilateral ligneous conjunctivitis. A new treatment approach and its outcome in this patient are described. CASE REPORT: We present the case of a 9-month-old Turkish girl with massive swelling of the eyelids and hard white pseudomembranes on both lids. The conjunctival smear was positive for Streptococcus pneumoniae. The clinical diagnosis was: ligneous conjunctivitis with superinfection. Histological investigation showed fibrin as major component of the pseudomembranes. The coagulation analyses revealed decreased plasminogen activity (<5%; normal 80-120%) and decreased plasminogen antigen (<0.4 mg/dl; normal 6-25 mg/dl). The failure of surgical therapy led to the attempt at treatment with intravenous lys-plasminogen. A significant improvement of the ocular symptoms occurred; stabilization with no recurrent pseudomembranes could be achieved for 6 months after treatment. DISCUSSION: The initial amelioration of symptoms in our patient after systemic replacement therapy confirms the etiological importance of plasminogen deficiency in the development of ligneous conjunctivitis. Curative treatment of ligneous conjunctivitis is still not available. However, intravenous application of plasminogen offers new possibilities in therapy, although long-term treatment seems necessary.

Conjunctiva↗
PubMed1989

Epidemiology and diagnosis of acute conjunctivitis at an inner-city hospital.

Chlamydia has been found to be the cause of a high percentage of cases of neonatal and chronic conjunctivitis in an inner-city population. To assess the etiology and epidemiology of acute conjunctivitis in this population, conjunctival scrapings were sampled from 45 patients presenting to an ocular emergency room; and replicate chlamydial, viral, and bacterial cultures and cytology tests were done. No cases of chlamydial conjunctivitis were diagnosed, although a viral etiology was established in 36% of the cases and a bacterial etiology in 40%. Twenty-four percent of the cases were not diagnosed. The authors recommend limiting the initial laboratory workup of patients with acute conjunctivitis to obtaining conjunctival smears for Gram and Giemsa staining. Chlamydial direct immunofluorescent monoclonal antibody (DFA) should be done if the patient is sexually active. Hyperacute conjunctivitis or acute conjunctivitis refractory to treatment mandates a more complete set of laboratory tests.

Acute Disease↗