2
Etiology
Table 2. Associated/Predisposing Factors for Conjunctivitis
Type of
Conjunctivitis Associated/Predisposing Factors
Allergic
Seasonal • Environmental allergens
Vernal • Hot, dry environments such as West Africa; parts of India, Mexico,
Central, North, and South America; and the Mediterranean area
• Environmental allergens for acute exacerbations
Atopic • Genetic predisposition to atopy
• Environmental allergens and irritants for acute exacerbations
Giant papillary
conjunctivitis
(GPC)
• Contact lens wear. (Risk factors include soft contact lenses,
infrequent lens replacement, prolonged wearing time, poor lens
hygiene, allergenic contact lens solutions, high water content or
poor contact lenses fit)
• Also occurs with irritation from exposed sutures and prostheses
Mechanical/Irritative/Toxic
SLK • Frequently associated with dysthyroid states, female gender
Contact-
lens-related
keratoconjunctivitis
• Occurs in association with contact lens wear as reaction to
mechanical irritation, chronic hypoxia, or preservatives
Floppy eyelid
syndrome
• Obesity, sleep apnea, upper-eyelid laxity, upper-eyelid excursion
over lower eyelid (eyelid imbrication)
Giant fornix
syndrome
• Elderly women (8th–10th decade), upper-eyelid ptosis with large
superior fornix, which holds coagulum of mucopurulent material
Pediculosis
palpebrarum
(Phthirus pubis)
• Typically sexually transmitted. May have associated pubic lice
or other sexually transmitted diseases. In children, may be an
indication of sexual abuse
Medication-induced
keratoconjunctivitis
• Glaucoma medications, antibiotics, antivirals, others; may
be associated with preservatives in all eye medications. Most
common with multiple eye medications and/or frequent dosing
Conjunctival
chalasis
• Previous eye surgery
• Dry eye
• Redundant conjunctivitis
Viral
Adenoviral • Exposure to infected individual (especially in school setting ),
recent ocular testing, concurrent upper respiratory infection
Herpes simplex
virus (HSV)
• Prior infection with HSV: trigger for reactivation such as stress,
other acute viral or febrile illnesses, ultraviolet (UV) exposure,
or trauma
• Primary HSV infection: exposure to infected individual
Varicella (herpes)
zoster virus (VZV)
• Acute chicken pox, exposure to an individual with active chicken
pox or recurrent VZV (shingles)
Molluscum
contagiosum
• Predominantly older children and young adults
• Immunocompromised state (e.g., human immunodeficiency virus
[HIV]) may predispose to multiple and/or large molluscum lesions
