10
Diagnosis
Table 4. Typical Clinical Signs of Conjunctivitis
Type of
Conjunctivitis Clinical Signs
Allergic
Seasonal • Bilateral. Conjunctival injection, chemosis, watery discharge,
mild mucous discharge
Vernal • Bilateral. Giant papillary hypertrophy of superior tarsal
conjunctiva, bulbar conjunctival injection, conjunctival scarring,
watery and mucoid discharge, limbal Trantas dots, limbal
"papillae," corneal epithelial erosions, corneal neovascularization
and scarring, corneal vernal plaque/shield ulcer
Atopic • Bilateral. Eczematoid blepharitis; eyelid thickening, scarring ;
lash loss; papillary hypertrophy of superior and inferior
tarsal conjunctiva; conjunctival scarring ; watery or mucoid
discharge; bogg y edema; corneal neovascularization, ulcers
and scarring ; punctate epithelial keratitis. Can be associated
with keratoconus and/or subcapsular cataract
GPC • Laterality associated with contact lens wear pattern. Papillary
hypertrophy of superior tarsal conjunctiva, mucoid discharge.
Papillae with white fibrotic centers can be seen in patients with
long-standing disease. In severe cases: lid swelling, ptosis
Mechanical/Irritative/Toxic
SLK • Bilateral superior bulbar injection, laxity, edema, and
keratinization. Superior corneal and conjunctival punctate
epitheliopathy, corneal filaments
Contact-lens-related
keratoconjunctivitis
• Ranges from mild to diffuse conjunctival injection,
focal or diffuse corneal neovascularization, peripheral or
circumferential corneal neovascularization, focal or diffuse
superficial punctate keratopathy. Papillary hypertrophy of
tarsal conjunctivitis is variable. May result from limbal stem
cell deficiency
Floppy eyelid
syndrome
• Upper eyelid edema; upper eyelid easily everted, sometimes by
simple elevation or lifting of lid; diffuse papillary reaction of
superior tarsal conjunctiva; punctate epithelial keratopathy;
pannus. Bilateral often asymmetric
Giant fornix
syndrome
• Enlarged superior fornix with coagulum of mucopurulent
material, ptosis
Pediculosis
palpebrarum
(Phthirus pubis)
• Unilateral or bilateral follicular conjunctivitis. Adult lice at the
base of the eyelashes, nits (eggs) adherent to the eyelash shafts,
blood-tinged debris on the eyelashes and eyelids
Medication-induced
keratoconjunctivitis
• Laterality based on drug use. Conjunctival injection, inferior
fornix and bulbar conjunctival follicles
• Distinctive signs: contact dermatitis of eyelids with erythema,
scaling in some cases
Conjunctival chalasis • Redundant conjunctivae
