International Council of Ophthalmology

ICO International Clinical Guidelines:

Ocular symptoms and signs (e.g., itching, discharge, irritation, pain, photophobia, blurred vision) [A:III]
Duration of symptoms [A:III]
Exacerbating factors [A:III]
Unilateral or bilateral presentation [A:III]
Character of discharge [A:III]
Recent exposure to an infected individual [A:III]
Trauma (mechanical, chemical, ultraviolet) [A:III]
Contact lens wear (e.g., lens type, hygiene and use regimen) [A:III]
Symptoms and signs potentially related to systemic diseases (e.g., genitourinary discharge, dysuria, upper respiratory infection, skin and mucosal lesions) [A:III]
Allergy, asthma, eczema [A:III]
Use of topical and systemic medications [A:III]
Use of personal care products [A:III]
Ocular history (e.g., previous episodes of conjunctivitis [A:III] and previous ophthalmic surgery) [B:III]
Systemic history (e.g., compromised immune status, current and prior systemic diseases) [B:III]
Social history (e.g., smoking, occupation and hobbies, travel and sexual activity) [B:III]

Visual acuity [A:III]
External examination
- Regional lymphadenopathy (particularly preauricular) [A:III]
- Skin [A:III]
- Abnormalities of the eyelids and adnexae [A:III]
- Conjunctiva [A:III]
Slit-lamp biomicroscopy
- Eyelid margins [A:III]
- Eyelashes [A:III]
- Lacrimal puncta and canaliculi [B:III]
- Tarsal and forniceal conjunctiva [A:II]
- Bulbar conjunctiva/limbus [A:II]
- Cornea [A:I]
- Anterior chamber/iris [A:III]
- Dye-staining pattern (conjunctiva and cornea) [A:III]

Cultures, smears for cytology and special stains are indicated in all cases of suspected infectious neonatal conjunctivitis. [A:I]
Smears for cytology and special stains are recommended in cases of suspected gonococcal conjunctivitis. [A:II]
Confirm diagnosis of adult and neonate chlamydial conjunctivitis with immunodiagnostic test and/or culture. [A:III]
Biopsy the bulbar conjunctiva and take a sample from an uninvolved area adjacent to the limbus in an eye with active inflammation when ocular mucous membrane pemphigoid is suspected. [A:III]
A full-thickness lid biopsy is indicated in cases of suspected sebaceous carcinoma. [A:II]

Avoid indiscriminate use of topical antibiotics or corticosteroids because antibiotics can induce toxicity and corticosteroids can prolong adenoviral infections and worsen herpes simplex virus infections [A:III]
Treat mild allergic conjunctivitis with an over-the-counter antihistamine/vasoconstrictor agent or second-generation topical histamine H₁-receptor antagonists. [A:I] If the condition is frequently recurrent or persistent, use mast-cell stabilizers. [A:I]
For contact lens-related keratoconjunctivitis, discontinue contact lens wear for 2 or more weeks. [A:III]
If corticosteroids are indicated, prescribe the minimal amount based on patient response and tolerance. [A:III]
If corticosteroids are used, perform baseline measurement of intraocular pressure. [A:III]
Use systemic antibiotic treatment for conjunctivitis due to Neisseria gonorrhoeae [A:I] or Chlamydia trachomatis. [A:II]
Treat sexual partners to minimize recurrence and spread of disease when conjunctivitis is associated with sexually transmitted diseases and refer patients and their sexual partners to an appropriate medical specialist. [A:III]
Refer patients with manifestation of a systemic disease to an appropriate medical specialist. [A:III]

Follow-up visits should include
- Interval history [A:III]
- Visual acuity [A:III]
- Slit-lamp biomicroscopy [A:III]
If corticosteroids are used, perform periodic measurement of intraocular pressure and pupillary dilation to evaluate for cataract and glaucoma [A:III]

Counsel patients with contagious varieties to minimize or prevent spread of diseases in the community. [A:III]
Inform patients who may require repeat short-term therapy with topical corticosteroid of potential complications of corticosteroid use. [A:III]
Advise patients with allergic conjunctivitis that frequent clothes washing and bathing/showering before bedtime may be helpful. [B:III]

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