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Table 4. Typical Clinical Signs of Conjunctivitis (cont'd)
Type of
Conjunctivitis Clinical Signs
Viral
Adenoviral • Abrupt onset. Unilateral or bilateral (often sequentially bilateral).
Varies in severity. Bulbar conjunctival injection, watery discharge,
follicular reaction of inferior tarsal conjunctiva, chemosis, eyelid
swelling, and erythema
• Distinctive signs: preauricular lymphadenopathy, petechial and
subconjunctival hemorrhage, corneal epithelial defect, multifocal
epithelial punctate keratitis evolving to anterior stromal keratitis,
membrane/pseudomembrane formation, eyelid ecchymosis
HSV • Unilateral. Bulbar conjunctival injection, watery discharge, mild
follicular reaction of conjunctiva. May have palpable preauricular
node
• Distinctive signs: vesicular rash or ulceration of eyelids,
pleomorphic or dendritic epithelial keratitis of cornea or
conjunctiva
VZV • Unilateral or bilateral. Bulbar conjunctival injection, watery
discharge, mild follicular reaction of conjunctiva. May have
palpable preauricular node. Typically punctate keratitis in
primary disease; punctate or dendritic keratitis in recurrent
disease
• Distinctive signs: vesicular rash or ulceration of eyelids,
pleomorphic or dendritic epithelial keratitis of cornea or
conjunctiva
Molluscum
contagiosum
• Typically unilateral, but can be bilateral. Mild to severe follicular
reaction, punctate epithelial keratitis. May have corneal pannus,
especially if longstanding
• Distinctive signs: single or multiple shiny, dome-shaped
umbilicated lesion(s) of the eyelid skin or margin
Bacterial
Nongonococcal • Unilateral or bilateral. Bulbar conjunctival injection, purulent or
mucopurulent discharge
Gonococcal • Unilateral or bilateral. Marked eyelid edema, marked bulbar
conjunctival injection, marked purulent discharge, preauricular
lymphadenopathy
• Important sign to detect: corneal infiltrate or ulcer, which often
begins superiorly
Chlamydial
Neonate/Infant • Unilateral or bilateral. Eyelid edema, bulbar conjunctival injection,
discharge may be purulent or mucopurulent, no follicles
Adult • Unilateral or bilateral. Bulbar conjunctival injection, follicular
reaction of tarsal conjunctiva, mucoid discharge, corneal pannus,
punctate epithelial keratitis, preauricular lymphadenopathy
• Distinctive sign: bulbar conjunctival follicles
