Page 37 - NAME OF CONDITION: REFRACTIVE ERRORS

5. Bulbar conjunctiva and limbus for follicles, edema, nodules, chemosis, laxity,
papillae, ulceration, scarring, phlyctenules, hemorrhages, foreign material,
keratinization.
6. Cornea for coarse punctate keratitis, epithelial defects, filaments, ulceration,
infiltrations including sub epithelial infiltrates and phlyctenules.
Specific helpful clues in differentiating the causes of conjunctivitis are listed below.

1. Bacterial conjunctivitis
o Preauricular adenopathy sometimes occurs; chemosis (thickened, boggy
conjunctiva) is common.
o Discharge is copious; discharge quality is thick and purulent. Conjunctival
injection is moderate or marked.
2. Viral conjunctivitis
o Preauricular adenopathy is common in epidemic keratoconjunctivitis and

herpes; chemosis is variable.
o Discharge amount is moderate, stringy, or sparse; discharge quality is thin
and seropurulent. Conjunctival injection is moderate or marked.
3. Chlamydial conjunctivitis tends to be chronic with exacerbation and remission.
o Preauricular adenopathy is occasional; chemosis is rare.
Discharge amount is minimal; discharge quality is seropurulent. Conjunctival
injection is moderate
4. Allergic conjunctivitis is characterized by acute or subacute onset, no pain, and

no exposure history.
o Pruritus is extremely common. Clear, watery discharge is typical with or
without a moderate amount of mucous production.
o An aggressive form of allergic conjunctivitis is vernal conjunctivitis in children
and atopic conjunctivitis in adults. Vernal disease often is associated with
shield corneal ulcers. Perilimbal accumulation of eosinophils (Horner-Trantas
dots) typifies vernal disease. Vernal keratoconjunctivitis (VKC), usually
affecting young boys, tends to be bilateral and occurs in warm weather. VKC
is presumed to be a hypersensitivity to exogenous antigens and may be
associated with or accompanied by keratoconus.
5. Giant papillary conjunctivitis resembles vernal disease.

o This condition occurs mainly in contact lens wearers who develop a syndrome
of excessive pruritus, mucous production, and increasing intolerance to
contact use.
o Bilateral disease typically is infectious or allergic.
o Unilateral disease suggests toxic, chemical, mechanical, or lacrimal origin.
o Intraocular pressure, pupil size, and light response are all normal.
o Ciliary flush, corneal staining, and anterior chamber reaction is absent unless
a significant amount of keratitis is associated (as seen in EKC).
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