6
Etiology
Table 3. Natural History of Conjunctivitis (cont'd)
Type of
Conjunctivitis Natural History Potential Sequelae
Bacterial
Nongonococcal • Mild: self-limited in
adults. May progress to
complications in children
• Severe: may persist without
treatment, rarely hyperacute
• Rare, but possibly corneal
infection, preseptal cellulitis
• Corneal infection: may be
associated with pharyngitis,
otitis media, meningitis
Gonococcal
Neonate Manifests within 1–7 days aer
birth, later if a topical antibiotic
was used. Rapid evolution to
severe, purulent conjunctivitis
Corneal infection, corneal
scarring, corneal perforation,
septicemia with arthritis,
meningitis
Adult Rapid development of severe
hyperpurulent conjunctivitis
Corneal infection, corneal
scarring, corneal perforation,
urethritis, pelvic inflammatory
disease, septicemia, arthritis
Chlamydial
Neonate Manifests 5–19 days following
birth, earlier if placental
membranes have ruptured prior
to delivery. Untreated cases may
persist for 3–12 months
Corneal scarring, conjunctival
scarring ; up to 50% have
associated nasopharyngeal,
genital, or pulmonary infection
Adult May persist if untreated Corneal scarring,
neovascularization, conjunctival
scarring, urethritis, salpingitis,
endometritis, perihepatitis,
follicular conjunctivitis
Immune-mediated
OMMP Onset generally over age 60.
Slowly progressive chronic
course, sometimes with
remissions and exacerbations
Conjunctival scarring and
shrinkage; symblepharon;
trichiasis; corneal scarring,
neovascularization, ulceration;
ocular surface keratinization;
bacterial conjunctivitis;
cicatricial lid changes; severe
tear deficiency; severe vision loss
