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Nursing Guide to Conjunctivitis: Nursing Diagnosis, Interventions, & Care Plans

Updated On 6 Minute Read

Conjunctivitis Etiology and Epidemiology

Conjunctivitis is an inflammation of the ocular and periocular tissues (DynaMed, 2018a). It presents as eye redness, itching, drainage, or swelling. Conjunctivitis is classified as either noninfectious or infectious and also as acute, chronic, or recurrent.

Conjunctivitis is typically caused by allergies, a virus, or a bacterial infection. Infectious conjunctivitis is caused by a virus or bacteria entering the eye (DynaMed, 2018a). Adenovirus is the cause of 65% to 90% of all viral conjunctivitis cases. Allergic conjunctivitis is caused by a reaction to an allergen that comes in contact with the eye (DynaMed, 2018b).

According to the Centers for Disease Control and Prevention, (2021), some other causes of conjunctivitis include:

  • Chemicals
  • Contact lenses
  • Foreign bodies
  • Air pollution
  • Fungi
  • Ameba and parasites
  • Gonorrhea or chlamydia in the birth canal

Conjunctivitis is quite common and accounts for approximately 1% of all primary care visits in the U.S. (DynaMed, 2018a). Viral conjunctivitis is the most common form and is more prevalent in warmer months for adults and colder months for children. In 20% of children, conjunctivitis is associated with acute otitis media and is often caused by the Haemophilus influenzae bacteria (CDC, 2021).

Symptoms of conjunctivitis include:

  • Reddening of conjunctiva
  • Swelling of conjunctiva
  • Increasing tear production
  • Feeling as if a foreign body is in the eye
  • Itching, irritation, and burning
  • Discharging pus or mucus from the eye
  • Crusting of eyelids, worse in the morning or after resting
  • Feeling discomfort while wearing contact lenses

Because viruses and bacteria can cause conjunctivitis, it can be very contagious. The cause of conjunctivitis will determine if and how it is transmitted. Typically, conjunctivitis spreads by:

  • Close contact such as touching or shaking unwashed hands after contact with the eye
  • Through the air by coughing or sneezing
  • By touching a contaminated object, then touching the eye
  • Multidose eyedrop vials

Conjunctivitis Diagnosis

Diagnosis of conjunctivitis is made on the findings of the examination. An individual with conjunctivitis will typically present with complaints of:

  • Conjunctival redness
  • Ocular discharge
  • Sticky eyelids after sleep
  • Itching, burning, or scratching of the eye
  • Pain and/or photophobia

Upon examination, the healthcare provider may see:

  • Eye discharge
  • Pink or red conjunctiva
  • Light intolerant

Differential diagnosis can be made based on the type of ocular discharge, such as:

  • Serous discharge without itching
    • Viral conjunctivitis or dry eye syndrome
  • Serous discharge with itching
    • Allergic conjunctivitis or dry eye syndrome
  • Mucopurulent discharge
    • Bacterial conjunctivitis (nongonococcal)
  • Hyperpurulent discharge
    • Gonococcal/chlamydial conjunctivitis (neonates)

Management

Treatment by a healthcare provider is not always necessary for conjunctivitis (CDC, 2021). Cool compresses and over-the-counter artificial tears can relieve discomfort until viral conjunctivitis clears.

Individuals who wear contact lenses should stop wearing them until their eye doctor tells them it is okay to wear them again. Cold symptoms usually accompany viral conjunctivitis, so the healthcare provider will inquire about a history of a recent cold.

Individuals with conjunctivitis should seek medical care if they have any of the following symptoms:

  • Eye pain
  • Sensitivity to light
  • Blurred vision
  • Intense conjunctival redness
  • Symptoms that do not improve within 24 hours
  • Any individual with a weakened immune system
  • Newborns with symptoms of conjunctivitis

Medical treatment for viral conjunctivitis may be needed if symptoms do not clear up or worsen. Antiviral medication such as acyclovir ophthalmic (Avaclyr®) can treat these infections (Hoffman, 2020). Antibiotics will not improve viral conjunctivitis.

Bacterial conjunctivitis is treated with antibiotics such as (Miyazaki et al., 2020):

  • Ciprofloxacin (Ciloxan®)
  • Erythromycin (Romycin®Ophthalmic)
  • Trimethoprim/polymyxin B (Polytrim®)

The antibiotics are administered in the form of eye drops or eye ointment. The use of antibiotics can help shorten the length of infection and reduce the spread.

Antibiotics are given for the following types of conjunctivitis:

  • Bacterial
  • Herpes simplex virus
  • Gonococcal
  • Chlamydial

Conjunctivitis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for conjunctivitis are listed below.

Assessment

Assess signs and symptoms, such as:

  • Visual acuity
  • Vital signs
  • Pain level
  • Eye redness, swelling, or drainage
  • History of recent cold or illness
  • Excessive tearing
  • Sensitivity to light
  • Contact lens wearer
  • Recent eye injury

Nursing Diagnosis/Risk For

  • Acute pain as evidenced by (Phelps, 2021a):
    • Redness and/or swelling of the conjunctiva
    • Excessive tearing
    • Complaints of eye pain
  • Risk for injury related to visual disturbance as evidence by (Phelps, 2021b):
    • Redness or swelling of the conjunctiva
    • Sensitivity to light
    • Eye pain
  • Deficient knowledge as evidenced by (Phelps, 2021c):
    • Lack of knowledge about the disease
    • Lack of knowledge on preventing cross-contamination

Conjunctivitis Interventions

  • Teach proper hand hygiene and instruct to perform hand hygiene before and after touching the eye.
  • Instruct to avoid sharing personal items until infection is clear.
  • If only one eye is affected, instruct on preventing cross-contamination to the other eye.
  • Instruct the individual to replace all cosmetics as soon as the infection has cleared.
  • Instruct individual on the proper administration of eye drops or ointments.
  • Instruct the individual not to wear contacts until their eye doctor says it is ok.
  • Instruct to avoid rubbing eyes.
  • Administer medications as ordered, such as decongestants, steroids, and anti- inflammatory eye drops.
  • Apply cool compresses for 10 minutes to relieve eye pain.
  • Wash eyes in warm water to remove crusting due to excess drainage.

Expected Outcomes

  • Improved redness, swelling, and drainage from eyes
  • Verbalizes diminished or absent eye pain
  • Verbalizes decreased or absent sensitivity to light

Individual/Caregiver Education

  • Performing proper hand hygiene
  • Preventing cross-contamination of eyes and to others
    • Avoid rubbing eyes.
    • Clean eye drainage with new tissue for each eye, then discard immediately.
    • Do not share items or handle items that others in the household will touch.
  • Instilling eye medications
  • Reviewing discharge instructions such as:
    • Apply compresses to relieve pain.
    • Use artificial tears for irritation.
    • Do not share personal items or things, like towels or face cloths.
    • Wash hands thoroughly before and after contact with eyes.
    • Use a new tissue each time you wipe your eye.
    • Discard makeup such as mascara. Do not use makeup until the infection clears.
    • Wear sunglasses if sensitive to light.
    • Return to a healthcare provider if the condition worsens or the drainage changes color.
    • Children should stay at home according to the policy the day care or school has in place. This will be a minimum of 24 hours.
    • Adults should stay home until place of work/school policy states it is okay to return.

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

Content Contributor

Content created/revised by Kathleen Koopmann, RN, BSN, PCCN

Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.

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Kathleen Koopmann, RN, BSN, PCCN

Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.