Which physical findings are characteristic of bacterial 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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Conjunctival injection may be present segmentally or diffusely. The everted inferior or superior palpebral conjunctival pattern may hold clues to the etiology.

Using slit-lamp biomicroscopy and everting both the upper and lower eyelids, follicles or papillae can be identified on the inflamed conjunctiva. Follicles, more common in the lower lid conjunctiva, have blood vessels that circumscribe the base of tiny elevated lesions. Follicles are characteristic of a hypersensitivity conjunctivitis (eg, due to brimonidine [Alphagan] or trifluorothymidine [Viroptic] drops), viral conjunctivitis, or chlamydial conjunctivitis or allergy to contact lens solution preservatives. Papillae, seen commonly in the conjunctiva of the upper lid, have vessels coming up the center of the tiny elevated lesion and are characteristic of bacterial or allergic conjunctivitis.

The discharge in bacterial conjunctivitis is typically more purulent than the watery discharge of viral or allergic conjunctivitis. Thus, there is more "mattering" of the lid margins and associated difficulty in prying the lids open following sleep. The mucopurulent discharge can appear white, yellow, or even greenish in color.

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