How is serious eye disease differentiated from 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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Traditional teaching suggests that significant eye pain, loss of vision, and photophobia are indications of serious eye disease. Anisocoria and ocular pain during pupillary constriction (even during a pencil push-up test) can also indicate serious eye diseases. [5] However, note that the absence of photophobia and anisocoria does not rule out the possibility of such serious diseases. Conversely, complete redness of the conjunctiva obscuring the tarsal vessels, purulent discharge, matting of both eyes in the morning, and onset during winter or spring all increase the probability of bacterial conjunctivitis. [5] If the patient has symptoms of itchy eyes and recurrent conjunctivitis, bacterial conjunctivitis is unlikely. [21] Dense deep-red to violaceous coloring of the conjunctiva that does not blanche with topical sympathomimetics (eg, phenylephrine 2.5%) indicates scleritis in the context of significant pain.

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