1. Serous discharge (watery) is most commonly associated with viral or allergic ocular conditions.

2. Mucoid discharge (stringy or ropy) is highly characteristic of allergy or dry eyes.

3. Mucopurulent or purulent discharge, often associated with morning crusting and difficulty opening the eyelids, strongly suggests a bacterial infection. The possibility of Neisseria gonorrhoeae infection should be considered when the discharge is copiously purulent.

Differential Diagnosis of Red Eye




Infectious. Bacterial, viral, fungal


Noninfectious. Recurrent epithelial

Bacterial (eg, staphylococcus,

erosion, foreign body





Allergic conjunctivitis

Acute glaucoma

Dry eye

Eyelid abnormalities

Toxic or chemical reaction

Orbital disorders

Contact lens use

Preseptal and orbital cellulitis

Foreign body

Idiopathic orbital inflammation

Factitious conjunctivitis


C. Itching is highly suggestive of allergic conjunctivitis. A history of recurrent itching or a personal or family history of hay fever, allergic rhinitis, asthma or atopic dermatitis is also consistent with ocular allergy.

D. Unilateral or bilateral conjunctivitis. Bilateral conjunctivitis suggests allergic conjunctivitis. Unilateral conjunctivitis is associated with infections caused by viruses and bacteria.

E. Pain, photophobia and blurred vision. Pain and photophobia do not usually occur with conjunctivitis, and these findings suggest an ocular or orbital disease processes, including uveitis, keratitis, acute glaucoma or orbital cellulitis. Blurred vision is not characteristic of conjunctivitis. This finding is indicative of corneal or intraocular pathology.

F. Recent contact with an individual with an upper respiratory tract infection suggests adenoviral conjunctivitis. Chlamydial or gonococcal infection may be suggested by the patient's sexual history, including a history of urethral discharge.

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