Differential diagnoses - Conjunctivitis and iritis in pictures

Dr Nigel Stollery offers advice on differentiating between allergic and infective eye conditions and provides advice on management.

Acute iritis

Presentation

  • Painful inflammation of the iris
  • Uncommon in children – can be acute, chronic or relapsing
  • May be associated with other conditions, such as rheumatoid arthritis, Behçet’s disease, malignancy, trauma to eye, infection

Management

  • Usually requires referral to secondary care
  • Treatment is usually with steroid eyedrops and cycloplegic drops
  • Dark glasses may be helpful if there is photophobia
  • Oral analgesia, such as paracetamol, can be beneficial
  • Chronic cases may require immunosuppressant medication

Viral conjunctivitis

Presentation

  • Common condition (more common than bacterial form)
  • Presents with pink conjunctiva and dilated blood vessels
  • Not usually associated with pain, photophobia or visual disturbance
  • Discharge unusual, although the eye may water excessively
  • Often associated with a viral URTI

Management

  • A benign, self-limiting condition
  • Antibiotics are of little help
  • Cold compresses may be beneficial


Bacterial conjunctivitis

Presentation

  • Benign condition caused by infection of the conjunctiva
  • Common (can occur at any age) and may be unilateral or bilateral
  • Conjunctiva become red and inflamed, with dilated blood vessels, but not usually painful
  • Discharge usually present and tends to be thick

Management

  • Usually managed in primary care or by pharmacist
  • Bathing helpful in removing the discharge
  • Topical antibiotic ointment or eyedrops can help
  • If diagnosis is in doubt, swabs can be helpful

Allergic conjunctivitis

Presentation

  • Irritation of conjunctiva by allergen, such as pollen
  • Both eyes usually affected – rapid onset after exposure
  • Eyes usually itchy, with red or pink appearance
  • Eyelids may swell and there may be a burning sensation
  • Pain, photophobia and visual disturbance not usually present

Management

  • Antihistamine drops can help
  • Patient should avoid allergens and rubbing the eyes
  • Bathing with cold water can be of benefit
  • In severe cases, steroid eyedrops may be required

Dr Nigel Stollery is a GP in Leicestershire

Click here to take a test on this article and claim your certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus