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Bacterial Conjunctivitis

Viral Conjunctivitis

Chlamydial Conjunctivitis

Allergic Conjunctivitis


Papillae (inflammatory response)

Follicles (indicative of viral etiology)

Follicles (in chronic/severe cases)

Papillae ("cobblestone" in chronic cases)


Less common

Less itchy

Not prominent

Hallmark symptom, often severe


Mild tearing

Watery discharge

Mild to moderate tearing

Increased tearing


Purulent (yellow/green)

Watery to slightly mucous


Watery or stringy mucus

Associated Symptoms

Mild sore throat or fever (occasionally)

Swollen preauricular lymph nodes, fever, sore throat

May involve cornea, lead to scarring; fever, sore throat

Sneezing, nasal congestion, runny nose


Antibiotic eye drops/ointments (e.g., erythromycin, polymyxin B-trimethoprim, fluoroquinolones)

Supportive care (cool compresses, artificial tears); Antiviral medications for herpes (e.g., acyclovir, valacyclovir)

Systemic antibiotics (azithromycin, doxycycline); Eye hygiene; Partner treatment

Antihistamine/Mast Cell Stabilizer eye drops (e.g., olopatadine); Avoid allergens; Cool compresses; Oral antihistamines; Corticosteroid eye drops (severe cases)


Good eye hygiene; Avoid touching eyes; Frequent hand washing

Good hygiene; Avoid sharing towels/cosmetics; Isolation precautions

Good eye hygiene; Prevent spread and reinfection

Identify and avoid triggers

Image credit: "Conjunctiva Reaction: Papillae & Follicles" sourced from Adult & Child Eye Care - Bacterial Conjunctivitis

  • Follicles/Papillae: More likely to have papillae due to the inflammatory response to bacterial infection.

  • Itching: Less common compared to allergic conjunctivitis.

  • Tearing: Mild tearing may be present.

  • Discharge: Purulent (pus-like) discharge, often yellow or green, causing eyelids to stick together, especially upon waking.

  • Associated Symptoms: May occasionally have mild sore throat or fever in severe infections or systemic involvement.

  • Antibiotic Therapy: Topical antibiotic eye drops or ointments are the mainstay of treatment. Common choices include erythromycin ointment or antibiotic drops like polymyxin B-trimethoprim. For more severe infections, fluoroquinolones (e.g., ofloxacin, moxifloxacin) can be used.

  • Hygiene: Patients should be advised to maintain good eye hygiene, avoid touching their eyes, and wash their hands frequently to prevent spreading the infection.

  • Warm Compresses: Applying warm compresses to the eyes can help relieve discomfort and remove crusts.

Viral Conjunctivitis

  • Follicles/Papillae: Follicles are characteristic, especially on the inner eyelids, indicating viral etiology.

  • Itching: Less itchy compared to allergic conjunctivitis.

  • Tearing: Watery discharge is more common.

  • Discharge: Watery to slightly mucous discharge.

  • Associated Symptoms: Swollen preauricular lymph nodes, fever, and sore throat can accompany the conjunctivitis, especially with adenoviral infections.

  • Supportive Care: Since most viral conjunctivitis is self-limiting, treatment focuses on relieving symptoms. Cool compresses, lubricating eye drops (artificial tears), and maintaining good hygiene are recommended.

  • Antiviral Medications: In cases caused by the herpes simplex virus, topical or oral antiviral medications, such as acyclovir or valacyclovir, are necessary.

  • Isolation Precautions: Patients should be educated on minimizing the spread of the virus, including avoiding sharing towels, cosmetics, or eye drops.

Chlamydial Conjunctivitis

  • Follicles/Papillae: Follicles can be present, especially in chronic or severe cases.

  • Itching: Itching is not a prominent symptom.

  • Tearing: Mild to moderate tearing.

  • Discharge: Mucopurulent discharge is characteristic.

  • Associated Symptoms: May involve the cornea and lead to scarring; often associated with systemic symptoms such as fever and sore throat in inclusion conjunctivitis.

  • Systemic Antibiotics: Requires oral antibiotics due to the systemic nature of the infection. Azithromycin (single dose) or a week-long course of doxycycline is effective. Erythromycin can be an alternative, especially for pregnant women.

  • Partner Treatment: Sexual partners should also be treated to prevent reinfection and control the spread of chlamydia.

  • Eye Hygiene: Similar to bacterial conjunctivitis, maintaining eye hygiene is crucial to prevent spread and reinfection.

Allergic Conjunctivitis

  • Follicles/Papillae: Papillae are common, especially "cobblestone" papillae under the upper eyelid in chronic cases.

  • Itching: Itching is a hallmark symptom, often severe.

  • Tearing: Increased tearing is a common response to allergen exposure.

  • Discharge: Usually watery or stringy mucus.

  • Associated Symptoms: Often accompanied by other allergic symptoms such as sneezing, nasal congestion, or a runny nose. Fever and sore throat are not typical unless there is concurrent allergic rhinitis.

  • Antihistamine/Mast Cell Stabilizer Eye Drops: These medications, such as olopatadine, can provide quick relief from itching and redness.

  • Avoid Allergens: Identifying and avoiding triggers is a key component of managing allergic conjunctivitis.

  • Cool Compresses: Can help alleviate itching and swelling.

  • Oral Antihistamines: May be helpful, especially if the patient is experiencing other systemic allergic symptoms. However, they can sometimes cause dry eyes.

  • Corticosteroid Eye Drops: Used for severe cases under close supervision due to potential side effects, including increased intraocular pressure and cataract formation.

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