LYCOS RETRIEVER 
Conjunctivitis: Patients
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The results of a literature search on the subject of conjunctivitis were reviewed by the Cornea/External Disease Panel and used to prepare the recommendations, which they rated in two ways. The panel first rated each recommendation according to its importance to the care process. This "importance to the care process" rating represents care that the panel thought would improve the quality of the patient's care in a meaningful way. The panel ... rated each recommendation on the strength of the evidence in the available literature to support the recommendation made.
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In severe adenoviral conjunctivitis, patients may have significant photophobia and foreign body sensation. Pseudomembranes of fibrin and inflammatory cells on the tarsal conjunctiva and/or focal corneal inflammation may blur vision. Even after conjunctivitis has resolved, residual corneal subepithelial opacities (multiple, coin-shaped, 0.5 to 1.0 mm in diameter) may be visible with a slit lamp for up to 2 yr. Corneal opacities occasionally result in decreased vision and significant glare.
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When conjunctivitis is associated with sexually transmitted disease, patients, as well as their sexual partners, should be referred to an appropriate medical specialist. [A:III] In cases of ophthalmia neonatorum due to gonococcus, Chlamydia, and herpes simplex virus, the infant's parents should be referred to an appropriate pediatric specialist. [A:III] When conjunctivitis appears to be a manifestation of systemic disease, patients should be referred for evaluation by an appropriate medical specialist. [A:III]
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The work-up of patients with chronic conjunctivitis and blepharoconjunctivitis involves culturing the conjunctiva and the eyelid margins to identify the predominant bacterial pathogen. Treatment includes the establishment of good eyelid hygiene using warm compresses and eyelid margin scrubs and the application of appropriate topical antimicrobials (e.g., erythromycin).5 Patients with meibomianitis and acne rosacea often benefit from oral tetracycline therapy. Systemic tetracyclines are contraindicated in nursing mothers, pregnant women and children. Topical metronidazole (Metrogel) is helpful in some patients with acne rosacea.
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Prehospital transport rarely is indicated for patients with conjunctivitis. More serious concerns may warrant emergency medical services (EMS) transport. Prehospital personnel should not overlook more serious comorbidity; they should focus on preventing transmission. Thorough hand washing by EMS personnel and glove use are necessary.
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A recent upper respiratory tract infection in the patient's home, school or workplace suggests a diagnosis of infectious conjunctivitis, especially of adenoviral origin. Chlamydial or gonococcal infection may be suggested by the patient's sexual history, including a history of urethral discharge.
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