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Acute Conjunctivitis Form

Complete Your Appointment in 5 Simple Steps: Choose your type, fill in details, and confirm!

1

Patient Information

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Note: Patients with open-angle glaucoma do not require referral as long as they are under supervised care. The negative implications of treating conjunctivitis in these patients would be very low.

Medical History

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Drug History

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Any red flag symptoms present?
Distinguishing Characteristics
Are symptoms typical of viral conjunctivitis?

Note: Generalized redness, serous (watery) or mucoserous discharge, grittiness, burning or irritation, minimal itching, conjunctival swelling, unilateral initially (may have progressed to bilateral; usually within 24-48 hours)

Are symptoms typical of bacterial conjunctivitis?

Note: Generalized redness, purulent or mucopurulent (thick, white/yellow/green) discharge, continues throughout the day and appears spontaneously, minimal itching, crusting of lids in the morning, unilateral initially (may have progressed to bilateral

Are current or past symptoms typical of allergic conjunctivitis?

Note: Generalized redness, major itching (cardinal symptom), serous or mucoid discharge, conjunctival swelling, bilateral presentation.

Review of Symptoms

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Available: Mon - Fri: 10 AM - 6 PM, Saturday: 10 AM - 2 PM

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