Conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of the eyelids. It has 2 parts, bulbar and palpebral. The bulbar portion begins at the edge of the cornea and covers the visible part of the sclera; the palpebral part lines the inside of the eyelids. Inflammation or infection of the conjunctiva is known as conjunctivitis and is characterized by dilatation of the conjunctival vessels, resulting in hyperemia and edema of the conjunctiva, typically with associated discharge.

Conjunctivitis affects many people and imposes economic and social burdens. It is estimated that acute conjunctivitis affects 6 million people annually in the United States. The cost of treating bacterial conjunctivitis alone was estimated to be $377 million to $857 million per year. Many US state health departments, irrespective of the underlying cause of conjunctivitis, require students to be treated with topical antibiotic eyedrops before returning to school.4

A majority of conjunctivitis patients are initially treated by primary care physicians rather than eye care professionals. Approximately 1% of all primary care office visits in the United States are related to conjunctivitis. Approximately 70% of all patients with acute conjunctivitis present to primary care and urgent care.

The prevalence of conjunctivitis varies according to the underlying cause, which may be influenced by the patient’s age, as well as the season of the year. Viral conjunctivitis is the most common cause of infectious conjunctivitis both overall and in the adult population and is more prevalent in summer. Bacterial conjunctivitis is the second most common cause and is responsible for the majority (50%-75%) of cases in children; it is observed more frequently from December through April. Allergic conjunctivitis is the most frequent cause, affecting 15% to 40% of the population, and is observed more frequently in spring and summer.

Conjunctivitis can be divided into infectious and noninfectious causes. Viruses and bacteria are the most common infectious causes. Noninfectious conjunctivitis includes allergic, toxic, and cicatricial conjunctivitis, as well as inflammation secondary to immune-mediated diseases and neoplastic processes. The disease can also be classified into acute, hyperacute, and chronic according to the mode of onset and the severity of the clinical response. Furthermore, it can be either primary or secondary to systemic diseases such as gonorrhea, chlamydia, graft-vs-host disease, and Reiter syndrome, in which case systemic treatment is warranted.

It is important to differentiate conjunctivitis from other sight-threatening eye diseases that have similar clinical presentation and to make appropriate decisions about further testing, treatment, or referral. An algorithmic approach using a focused ocular history along with a penlight eye examination may be helpful in diagnosis and treatment. Because conjunctivitis and many other ocular diseases can present as “red eye,” the differential diagnosis of red eye and knowledge about the typical features of each disease in this category are important.

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