An Update on Bacterial Conjunctivitis

    • CE credits 2 hours
    • COPE code 58573-AS / 115830
    • Available until Jul 9, 2021


Learning Objectives

  • To review the presentation of bacterial conjunctivitis, with a focus on features differentiating it from other forms of conjunctivitis.
  • To review treatment strategies and antibiotic choices for bacterial conjunctivitis.
  • To review the presentation and treatment of conjunctivitis caused by Neisseria gonorrhea.


A 17-year-old male presents to your office with a red left eye. He says that last night he began having pain, redness, and irritation, and upon wakening today the symptoms were much more severe. At first the discharge was scant, but over the course of the day worsened such that he has to continually wipe away “thick, green” material.

On exam, visual acuities are 6/6 in the right eye vs. 6/15 in the left eye. The right eye is not injected and is grossly normal on slit lamp examination. On examination of the left eye, there is severe injection and bogginess of the conjunctiva 360 degrees with abundant mucopurulent discharge. Peripheral corneal infiltrates and a 1+ cell reaction are also present. There is an enlarged preauricular lymph node on the left side.

External appearance of the left eye is shown below:

Quick Question

You suspect gonorrhea conjunctivitis and arrange for urgent antibiotic treatment. In addition to gonorrhea treatment, co-treatment of what infectious agent is recommended?

  • HIV

    Although gonorrhea conjunctivitis is sexually transmitted, treatment with HIV medications is not warranted.

  • Syphilis

    Although gonorrhea conjunctivitis is sexually transmitted, treatment with anti-treponemal agents is not warranted.

  • Chlamydia

    There is a high co-infection rate of chlamydia with gonorrhea.

  • Adenovirus

    The clinical picture does not describe that of adenovirus conjunctivitis.


Bacterial conjunctivitis is a relatively common infectious condition of the conjunctiva. It may present in all age groups, but is most prevalent in children. The typical presentation is that of an acute red eye with mucopurulent discharge, although the presentation may vary significantly. Treatment is with topical antibiotics.

As a whole, conjunctivitis constitutes a significant proportion of visits to primary care providers,1 accounting for an estimated 1% of all primary care visits in the United States.2 Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis (the most common cause is viral, and overall the most common cause of conjunctivitis is allergic). As many cases of conjunctivitis are treated at the primary care level with topical antibiotics, eye care professionals encounter patients with bacterial conjunctivitis relatively infrequently. The annual incidence of bacterial conjunctivitis is approximately 135 per 100,000.3

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