
Bacterial Conjunctivitis
Rapid Review
- Background
- Infection and inflammation of conjunctiva caused by bacteria (typically S. aureus). May be unilateral or affect both eyes. Commonly known as “pink eye”
- Pseudomonas aeruginosa most common cause for contact lens wearers
- Signs/Symptoms
- Itchy eyes w/ discharge or crusting; usually worse in the morning; may say eyes are “glued shut” when waking up.
- Exam will show red/pink eye with yellow, purulent discharge
- Diagnosis
- Clinical diagnosis
- Treatment
- Antibiotic eye drops (ex. gentamicin/tobramycin) or ointment (ex. erythromycin)
- For contact lens wearers, use fluoroquinolone drops (ciprofloxacin)
- Disposition
- Discharge is appropriate for most patients. Ophthalmology follow-up up required if the patient is a contact lens wearer or if there is a lack of improvement despite antibiotics.
- Admit patients with severe cases or those thought to be caused by gonorrhea.
Pearls
- Patients with conjunctivitis will usually continue to be contagious for up to 2 weeks, despite antibiotic treatment.
- Antibiotic drops are typically used for adults and older children, but ointment is preferable in young children due to better compliance.
Deep Dive

Blepharitis
Rapid Review
- Background
- Acute or chronic inflammation of the eyelid margins, most commonly caused by dysfunctional meibomian gland or staph infection
- Further divided into anterior and posterior blepharitis
- Signs/Symptoms
- Itchy/sore, tearing, blurry vision
- Crusting at lid margins, eye flaking, red-rimming of eyelid
- Diagnosis
- Slit-lamp exam
- Treatment
- Warm compresses, irrigation, massage
- Topical antibiotics (ex. erythromycin, bacitracin) if infection suspected
- Disposition
- Most patients can be discharged. Recommend ophthalmology follow-up for refractory cases.
Pearls
- Although typically caused by bacteria, blepharitis can sometimes be caused by viral pathogens such as herpes or VZV. These cases may require antivirals (acyclovir, valacyclovir)
- Some cases of bleparitis may be chronic due to meibonmian gland dysfunction. There may be a role for oral antibiotics in these cases (ex. azithromycin or doxycycline) as this helps alter the composition of skin bacteria and meibominan gland secretion.
Deep Dive

Corneal Foreign Body
Rapid Review
- Background
- Foreign material that becomes embedded on or in the corneal epithelium.
- Commonly caused by grinding or hammering metal w/o eye protection.
- Signs/Symptoms
- Eye pain, tearing, foreign body sensation, blurred/decreased vision (rare)
- (+) Seidel sign; suggests corneal perforation
- Diagnosis
- Slit lamp or X-ray
- Treatment
- Topical anesthetic, irrigation/cotton-swab
- Deep foreign bodies and rust rings may require removal by ophthalmologist
- Disposition
- Most patients can be discharged if the foreign body has been successfully removed and there was no penetration into the globe. Ophthalmology follow-up in 24 hours is required if a large defect or rust ring is left over.
- Admit any patient with retained foreign bodies. Consult ophthalmology.
Pearls
- Be especially careful with high impact metal projectiles (power tools, metal-on-metal impacts, weapons, etc.). These carry a greater risk of ocular involvement.
- Ultrasound may be useful for identifying intraocular foreign bodies, but should not be used for open globe injuries.
Deep Dive

Globe Rupture
Rapid Review
- Background
- Full thickness corneal/scleral injury, causing compromise to the globe.
- Occurs when blunt or penetrating force is applied to the eye, causing an abrupt rise in intraocular pressure. This is a vision threatening emergency
- Signs/Symptoms
- Eye pain, tearing, limited extraocular movements, hyphema, extrusion of intraocular contents, teardrop-shaped pupil
- Diagnosis
- Clinical diagnosis; CT can may help identify fractures or foreign bodies
- Do NOT perform tonometry (may worsen injury)
- Treatment
- Minimize intraocular pressure (pain control, nausea/vomiting control, antitussives, elevate head of bed). Update tetanus.
- Emergent ophthalmologic consultation for surgical management
- Disposition
- Admission with emergent ophthalmologic consultation is required for all cases of globe rupture.
Pearls
- Do not apply a gauze dressing alone to the eye (this adds very little protection). Protect the eye with a paper cup or commercial eye shield.
- Once a globe rupture is identified or suspected, be sure to minimize further examination until it is time to repair.
Deep Dive

Orbital Cellulitis
Rapid Review
- Background
- Infection of the orbital tissues behind the eye. Most often a complication of sinusitis, but can also occur from orbital trauma or tooth/ear infections.
- Most often affects children ages 7-12 years of age
- Signs/Symptoms
- Limited extraocular movement, proptosis, painful eye movements, fever
- Diagnosis
- Mostly clinical
- CT scan of orbits can confirm diagnosis
- Treatment
- Broad-spectrum antibiotics (ex. Vancomycin + Zosyn)
- Consult ophthalmology. May require surgical drainage.
- Disposition
- All cases of orbital cellulitis require admission.
Pearls
- Orbital cellulitis is differentiated from preseptal cellulitis through involvement of the orbital septum, which will cause pain w/ extraocular movements, proptosis, and decreased ocular motility.
- Several complications can arise from orbital cellulitis, including cavernous sinus thrombosis, meningitis, brain abscess, and orbital abscess.
Deep Dive