Bacterial Conjunctivitis vs Viral Conjunctivitis
Bacterial Conjunctivitis and Viral Conjunctivitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Bacterial Conjunctivitis vs Viral Conjunctivitis at a glance
- Bacterial Conjunctivitis: Acute purulent conjunctival infection — most often self-limited; topical antibiotics shorten course.
- Viral Conjunctivitis: Highly contagious viral inflammation of conjunctiva — typically adenovirus; supportive care only.
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Side-by-side comparison
| Feature | Bacterial Conjunctivitis | Viral Conjunctivitis |
|---|---|---|
| At a glance | Acute purulent conjunctival infection — most often self-limited; topical antibiotics shorten course. | Highly contagious viral inflammation of conjunctiva — typically adenovirus; supportive care only. |
| Classic presentation | Bilateral mucopurulent discharge with eyelids matted shut on awakening and normal vision in a school-age child.; Eye redness, often beginning unilateral and spreading to fellow eye in 1-2 days; Mucopurulent (yellow/green) discharge throughout the day; Eyelids matted/stuck shut on awakening; Foreign body or 'gritty' sensation; Minimal or… | Watery red eye with follicular reaction, ipsilateral preauricular lymphadenopathy, and recent URI in an adult.; Acute red eye, often beginning unilateral and spreading to fellow eye within days; Watery discharge — clear, profuse; Foreign body or gritty sensation, burning; Mild eyelid swelling and crusting (less than bacterial); Recent… |
| Workup / key labs | Most cases: clinical diagnosis; no testing needed; Gram stain and culture if: hyperacute presentation, contact lens wearer, severe disease, neonate, immunocompromised, treatment failure; NAAT for Chlamydia trachomatis and Neisseria gonorrhoeae in adults with suspected STI conjunctivitis or in neonatal conjunctivitis | Clinical diagnosis usually sufficient; Rapid adenovirus antigen test (e.g., AdenoPlus) available in some settings — useful for outbreak control and to avoid unnecessary antibiotics; Viral culture or PCR rarely needed; consider for atypical, severe, or HSV/VZV suspected cases; NAAT for chlamydia/gonorrhea if STI exposure or chronic… |
| Imaging | Slit-lamp examination if any pain, photophobia, decreased vision, contact lens wear, or treatment failure — exclude keratitis or iritis; Fluorescein staining if corneal involvement suspected | Slit-lamp examination with fluorescein staining if photophobia, decreased vision, contact lens wear, or corneal involvement suspected — looks for dendrites (HSV), subepithelial infiltrates (EKC), or pseudodendrites (VZV) |
| First-line treatment | Most uncomplicated bacterial conjunctivitis is self-limited; topical antibiotics shorten course and reduce transmission; Topical ocular antibiotic — erythromycin ophthalmic ointment 0.5%, polymyxin B/trimethoprim drops, or moxifloxacin/ofloxacin drops × 5-7 days; Avoid topical aminoglycosides (gentamicin, tobramycin) as first line —… | Supportive care — viral conjunctivitis is self-limited (1-3 weeks); Cool compresses to reduce swelling; Artificial tears for lubrication and symptom relief; Strict hygiene: hand washing, no shared towels/pillows/eye drops, no cosmetics, no contact lens wear until resolved; Stay home from school/work until tearing and discharge resolve… |
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