Confusable diagnoses · PANCE / PANRE

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

FeatureBacterial ConjunctivitisViral Conjunctivitis
At a glanceAcute purulent conjunctival infection — most often self-limited; topical antibiotics shorten course.Highly contagious viral inflammation of conjunctiva — typically adenovirus; supportive care only.
Classic presentationBilateral 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 labsMost 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 conjunctivitisClinical 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…
ImagingSlit-lamp examination if any pain, photophobia, decreased vision, contact lens wear, or treatment failure — exclude keratitis or iritis; Fluorescein staining if corneal involvement suspectedSlit-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 treatmentMost 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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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.