What is conjunctivitis without discharge?

Conjunctivitis Without Discharge: Types and Characteristics

Conjunctivitis without discharge primarily refers to viral conjunctivitis, allergic conjunctivitis, or certain inflammatory conditions that present with conjunctival redness but minimal to no discharge. 1

Types of Conjunctivitis Without Discharge

Viral Conjunctivitis

• Presents with:

  • Abrupt onset
  • Unilateral or bilateral (often sequentially bilateral) involvement
  • Bulbar conjunctival injection (redness)
  • Watery or minimal discharge (compared to purulent discharge in bacterial cases)
  • Follicular reaction of inferior tarsal conjunctiva
  • Preauricular lymphadenopathy (distinctive sign)
  • Petechial and subconjunctival hemorrhages may occur 1

• Common viral causes:

  • Adenovirus (accounts for 80% of viral conjunctivitis) 2
  • Herpes simplex virus (HSV) - typically unilateral
  • Varicella zoster virus (VZV) - usually unilateral with distinctive vesicular dermatomal rash 3
  • SARS-CoV-2 - may present with minimal discharge 1

Allergic Conjunctivitis

• Characterized by:

  • Bilateral involvement
  • Conjunctival hyperemia (redness)
  • Chemosis (conjunctival swelling)
  • Minimal watery discharge
  • Itching (most consistent and characteristic symptom) 4, 5
  • May have papillary reaction depending on type

• Subtypes include:

  • Seasonal allergic conjunctivitis (hay fever conjunctivitis)
  • Atopic conjunctivitis
  • Vernal keratoconjunctivitis (with giant papillae on upper tarsal conjunctiva) 3
  • Giant papillary conjunctivitis (associated with contact lens use) 3

Other Non-Infectious Causes

• Mucus fishing syndrome:

  • Presents with conjunctival injection
  • Minimal discharge
  • Associated with repetitive mechanical removal of mucus 1

• Oculoglandular syndrome:

  • Unilateral follicular conjunctivitis
  • Associated with ipsilateral regional lymphadenopathy
  • Minimal discharge
  • Often caused by Bartonella henselae (cat scratch disease) 1

Differentiating Features from Conjunctivitis With Discharge

Key Differences

• Bacterial conjunctivitis typically presents with:

  • Purulent or mucopurulent discharge
  • Mattering and adherence of eyelids upon waking
  • Papillary reaction rather than follicular reaction 6, 4

• Gonococcal and chlamydial conjunctivitis present with:

  • Significant purulent discharge
  • More severe symptoms
  • Require systemic treatment in addition to topical therapy 3, 4

Diagnostic Approach

Clinical Assessment

• Evaluate for:
  • Conjunctival injection pattern (diffuse vs. localized)
  • Presence of follicles vs. papillae
  • Preauricular lymphadenopathy (suggests viral etiology)
  • Associated symptoms (itching suggests allergic etiology) 3
  • Vesicular lesions on eyelids (suggests herpetic infection) 3

Warning Signs Requiring Referral

• Refer to an ophthalmologist when:
  • Severe pain or visual impairment
  • Signs of corneal involvement
  • Chronic or recurrent red eye
  • No improvement after 10 days of treatment 3

Management Considerations

Viral Conjunctivitis

• Generally self-limiting (5-14 days)
• Supportive care:
  • Artificial tears
  • Cold compresses
  • Strict personal hygiene to prevent transmission 6

Allergic Conjunctivitis

• Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 6, 5
• Avoid topical corticosteroids without ophthalmologic consultation 3

Important Pitfalls to Avoid

• Misdiagnosing viral conjunctivitis (especially HSV or VZV) as bacterial, leading to inappropriate antibiotic use 3, 7
• Failing to recognize potentially serious causes of red eye without discharge (e.g., acute angle-closure glaucoma, uveitis)
• Missing signs of systemic disease that may present with conjunctivitis

Remember that the absence of discharge does not rule out infectious causes, particularly viral etiologies, which are the most common cause of acute conjunctivitis 4, 2.