When is bacterial culture indicated in the diagnosis of conjunctivitis (pink eye)?

Updated: Jan 03, 2019
  • Author: Karen K Yeung, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Routine bacterial culture is indicated for specific cases of clinically suspected bacterial disease. These are best obtained with a commercially available sterile red-top culturette using applicators that contain artificial fiber, rather than cotton-tip applicators, which have bacteriostatic properties. Although most routine cases of bacterial conjunctivitis should not require culture confirmation, certain presentations, such as the following, suggest utility to the astute clinician:

  • Neonatal conjunctivitis
  • Hyperacute conjunctivitis suggestive of N gonorrhoeae
  • Extremely elderly patients
  • Nursing home patients
  • Immunocompromised patients: HIV infection, chemotherapy, immunosuppressive therapy
  • Recurrent or recalcitrant conjunctivitis
  • Corneal allograft recipients
  • Patients who have undergone recent intraocular surgery: pars plana vitrectomy, cataract, glaucoma shunt
  • Patients with a thinning or damaged trabeculectomy filtering bleb
  • Methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE) carriers

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