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Conjunctivitis, commonly known as "pink eye," is a frequently encountered condition in primary care, with etiologies ranging from bacterial to viral, allergic, or other less common causes. Accurately diagnosing the cause can be challenging. Studies indicate that even centres with expertise in ocular surface disease had an accuracy rate of just 48% in correctly diagnosing adenoviral conjunctivitis.
This poses a diagnostic problem for clinicians, especially when treatment modalities differ substantially between bacterial and viral causes. The conventional wisdom on signs and symptoms as indicative of either bacterial or viral etiologies has recently come under scrutiny. Given the complexities, this article aims to provide a comprehensive table to guide primary care clinicians in distinguishing between bacterial and viral conjunctivitis based on the latest evidence.
| Feature | Bacterial Conjunctivitis | Viral Conjunctivitis (Adenoviral) | Notes and Specifics |
|---|---|---|---|
| Onset | Sudden | Gradual | The timing of second eye involvement may be indicative but is not definitive. |
| Affected Eye(s) | Often one eye, may spread to both | Usually both eyes | |
| Discharge | Purulent, yellow-green | Watery or mucoid | A purulent discharge does not definitively indicate bacterial aetiology. |
| Itching | May or may not be present | Common | Lack of itching was once thought to indicate bacterial aetiology but is now questioned. |
| Associated Symptoms | Possible... |
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