Acute conjunctivitis is a common disease in ophthalmic practice. To prescribe adequate treatment, the doctor must distinguish between a viral infection and a bacterial infection. As a rule, the diagnosis is based on the clinical picture of the disease. Additional diagnostic tests, such as cultural studies, are rarely used, as the results are only known after a few days.

It is common to prescribe local antibacterial therapy to patients diagnosed with acute bacterial conjunctivitis, although studies show that only half of patients with acute conjunctivitis, whose bacterial nature has been determined based on clinical symptoms, have been successful to isolate a clinically significant pathogen. In addition, according to several studies, the local use of antibiotics causes a positive trend on day 5 in only 31% of patients (compared to placebo). Thus, more than half of patients with acute infectious conjunctivitis receive unreasonable and not always effective treatment. Existing prescribing practices increase the risk of developing and spreading antibiotic resistance, adverse drug reactions and also increasing the cost of treatment.

In this regard, the primary importance is the question of whether it is possible, on the basis of the clinical picture, to determine whether the viral or bacterial nature is conjunctivitis. The authors of most ophthalmology textbooks answer this question positively and present symptoms considered to be diagnosed as important. The involvement of the second eye in the pathological process a few days after the first, an increase in the lacrimal gland, the follicular nature of the conjunctival lesion and the mucous nature of the discharge indicate the viral nature of the disease. The defeat of the second eye within 24 to 48 hours, the appearance of a mucopurulent discharge, the papillary or pseudomembranous character of the lesion of the conjunctiva more generally testify in favor of the bacterial etiology.

In order to determine whether the above symptoms are conclusive, R.P. Rietfild and colleagues (Denmark) conducted an analytical study of articles on the diagnosis of acute conjunctivitis. After reviewing all the data, they came to the conclusion that, despite the information provided in the ophthalmology textbooks, there is no objective evidence that it is possible to determine the etiology of infectious conjunctivitis solely from of the clinical picture of the disease. Additional research in this area is necessary in order to develop reliable objective criteria that will allow doctors to prescribe adequate treatment for this pathology.