Conjunctivitis
Key Points
- Conjunctivitis is conjunctival inflammation that may be infectious or noninfectious.
- Viral causes are most common, but bacterial, allergic, fungal, and parasitic etiologies occur.
- Discharge pattern, pain severity, and visual change help differentiate uncomplicated disease from urgent complications.
- Most cases are diagnosed clinically; testing is reserved for recurrent, resistant, neonatal, or STI-suspected cases.
- Nursing priorities are symptom relief, transmission prevention, and early escalation when vision-threatening cues appear.
Pathophysiology
Conjunctivitis develops when the conjunctival mucosa is exposed to infectious organisms or irritants. Local inflammatory response causes conjunctival vasodilation, producing diffuse red eye, swelling, discomfort, and discharge.
Clinical pattern varies by etiology. Bacterial disease more often causes purulent discharge that sticks to eyelashes, whereas viral and allergic forms more often produce watery discharge. Untreated severe infections can progress to corneal injury and vision compromise.
Classification
- Etiology class: Viral, bacterial, fungal, parasitic, or noninfectious (allergic/toxic-irritant).
- Duration class: Acute (up to about 4 weeks) and chronic (longer than 4 weeks).
- Risk-complication class: Neonatal/STI-associated disease, recurrent or treatment-resistant disease, and severe pain/vision-threat pattern.
Nursing Assessment
NCLEX Focus
Prioritize pain severity, visual acuity change, and discharge pattern to identify who needs urgent ophthalmology escalation.
- Assess unilateral or bilateral red eye, pain, itching, tearing, photophobia, foreign-body sensation, and sticky eyelids.
- Assess discharge character: purulent discharge supports bacterial cause; watery discharge is more consistent with viral or allergic etiology.
- Assess for concurrent URI symptoms and tender preauricular lymphadenopathy, which commonly accompany viral conjunctivitis.
- Assess visual acuity and pain trend using age-appropriate tools; worsening pain or acuity can indicate complications.
- Assess epidemiologic risk: newborn status, contact-lens use, recurrent infection, and STI exposure risk.
- Assess for complication cues, including severe pain, corneal involvement, or systemic signs suggesting invasive infection.
Nursing Interventions
- Implement etiology-based treatment support: topical antibiotics for bacterial disease, supportive care for most viral cases, and allergen-avoidance plus antihistamine strategy for allergic disease.
- Administer prescribed antibiotic/antiviral agents and monitor response to therapy.
- Provide symptomatic relief with cold compresses and lubricating artificial tears when indicated.
- Reinforce strict hand hygiene and no sharing of towels, cosmetics, or other personal eye-contact items.
- Teach not to touch/rub eyes and to avoid cross-contamination to the unaffected eye.
- Teach contact-lens users to stop lens wear during active infection and restart only after clinical resolution and provider guidance.
- Teach safe eye-drop/ointment technique: avoid touching medication tip to ocular surface.
- Escalate promptly for recurrent infection, severe pain, contact-lens complications, herpes-related concern, or persistent/worsening symptoms.
Vision-Loss Risk
Severe pain, reduced visual acuity, or suspected gonococcal/herpetic disease requires urgent specialist evaluation.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| ophthalmic-antibiotics | Topical ointment or drops | Use for bacterial conjunctivitis and reinforce full regimen completion. |
| antibiotics | Systemic therapy for gonococcal or chlamydial disease | Monitor for systemic complications and treatment response. |
| antiviral-medications | Herpes-related treatment regimens | Coordinate ophthalmology-directed care; monitor corneal risk. |
| antihistamines | Topical or oral agents | Useful in allergic conjunctivitis with trigger avoidance. |
| Ocular lubricants | Artificial tears | Improve comfort in viral or irritative disease. |
Clinical Judgment Application
Clinical Scenario
A school-age child presents with bilateral red, itchy, watery eyes, mild photophobia, and recent URI symptoms; vision is unchanged and pain is mild.
- Recognize Cues: Watery discharge plus URI-associated symptom cluster.
- Analyze Cues: Pattern is most consistent with uncomplicated viral conjunctivitis.
- Prioritize Hypotheses: Prevent transmission and monitor for complication progression.
- Generate Solutions: Symptom-relief care, hygiene education, and return precautions.
- Take Action: Start ordered supportive interventions and teach family contamination-control steps.
- Evaluate Outcomes: Symptoms improve, no spread to close contacts, and no visual decline occurs.
Related Concepts
- eye-assessment-visual-acuity-and-common-abnormalities - Baseline ocular assessment and visual-acuity monitoring.
- hand-hygiene - Core prevention step for reducing transmission.
- portal-of-entry - Conjunctival mucosa as an infectious entry route.
- sexually-transmitted-infections - Gonococcal and chlamydial conjunctivitis risk context.
- ear-assessment-hearing-tests-and-common-abnormalities - Neonatal chlamydial conjunctivitis can co-occur with otitis risk.
Self-Check
- Which conjunctivitis findings suggest urgent ophthalmology referral?
- Why does discharge pattern help with etiology-focused triage?
- Which home-care behaviors most effectively reduce household spread?