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ULY CLINIC

9 Septemba 2025, 05:34:01

Eye Discharge

Eye discharge, defined as any excretion from the eye other than tears, may be unilateral or bilateral and ranges from scant to copious. Causes include infectious, inflammatory, and systemic conditions, and prompt evaluation is essential to prevent vision-threatening complications.

Pathophysiology

Eye discharge occurs when inflammatory, infectious, or obstructive processes disrupt normal tear production or ocular surface integrity. Mechanisms include bacterial, viral, or fungal infections; immune-mediated inflammation; obstruction of the lacrimal apparatus; meibomian gland dysfunction; or systemic diseases affecting ocular tissues.

Clinical Assessment

History Taking

Onset, duration, and progression of discharge
Laterality: unilateral or bilateral
Character: purulent, mucoid, serous, frothy, cheesy, stringy
Associated symptoms: pain, photophobia, itching, burning, foreign body sensation, tearing, fever
Recent infections or trauma
Drug exposure, including prophylactic neonatal eye medications
Systemic disorders (autoimmune, dermatologic, or infectious diseases)

Physical Examination

Inspect discharge: quantity, color, consistency
Examine external structures: eyelids (edema, lesions, trichiasis, crusts), conjunctiva (injection, follicles), cornea (cloudiness, ulcers)
Test visual acuity with and without correction
Assess eyelid movement and exophthalmos if present
Evaluate extraocular movements (six cardinal directions)
Special attention to the pediatric population and neonates, who may have unique etiologies

TIP on identifying sources of eye discharge

Eye discharge may originate from the tear sac, punctum, meibomian glands, or canaliculi. If the patient reports discharge that is not immediately visible, gently apply pressure with your fingertip over these structures to express a small sample. Carefully observe and characterize the discharge, noting its consistency, color, and the exact anatomical source, as this can help guide diagnosis and management.

Medical Causes

Table 1: Causes of Eye Discharge – Distinguishing Features and Key Clinical Information

Cause	Clinical Features / Distinguishing Signs	Distribution / Pattern	Other Key Information / Considerations
Allergic Conjunctivitis	Bilateral, white, ropey discharge; itching, tearing	Both eyes	Often seasonal or triggered by allergens; absence of purulence
Bacterial Conjunctivitis	Moderate purulent or mucopurulent discharge; crusting on eyelids, itching, burning, foreign body sensation; eye pain if cornea involved	Usually unilateral	Green/yellow discharge; preauricular adenopathy uncommon; treat with topical antibiotics
Viral Conjunctivitis	Clear, serous discharge; preauricular adenopathy; history of URTI	Usually unilateral	Self-limited; supportive care; highly contagious
Fungal Conjunctivitis	Thick, purulent discharge; eyelid edema, redness, itching	Often unilateral	Corneal involvement may cause pain, photophobia; more common in immunocompromised
Inclusion Conjunctivitis	Scant mucoid discharge, pseudoptosis, conjunctival follicles	Both eyes	Morning predominance; often chlamydial etiology
Corneal Ulcers (Bacterial/Fungal)	Copious purulent discharge; crusty eyelids; pain, photophobia, impaired visual acuity	Usually unilateral	Bacterial: gray-white irregular corneal opacity; Fungal: dense whitish-gray central ulcer with peripheral clearing
Stevens-Johnson Syndrome / Erythema Multiforme Major	Purulent discharge; entropion, trichiasis, photophobia; systemic bullous skin lesions	Both eyes	Life-threatening; requires hospitalization and supportive care
Herpes Zoster Ophthalmicus	Moderate to copious serous discharge; eyelid edema, conjunctival injection; severe unilateral facial pain precedes vesicles	Usually unilateral	Early antiviral therapy recommended to prevent complications
Keratoconjunctivitis Sicca (Dry Eye Syndrome)	Continuous mucoid discharge; insufficient tearing; redness, burning, foreign body sensation	Bilateral	Chronic; may require lubricating drops or punctal plugs
Meibomianitis	Frothy discharge; soft cheesy yellow material expressed from glands; chronically red eyelids	Usually bilateral	Chronic condition; warm compresses and eyelid hygiene indicated
Orbital Cellulitis	Unilateral purulent discharge; eyelid edema, conjunctival injection; fever, headache, orbital pain; limited eye movement	Usually unilateral	Ophthalmologic emergency; requires IV antibiotics
Psoriasis Vulgaris	Mucus discharge; redness; eyelid lesions extending to conjunctiva	Usually bilateral	Associated with chronic dermatologic disease
Trachoma	Bilateral discharge; pain, tearing, photophobia, conjunctival follicles	Both eyes	Common in endemic areas; preventable with hygiene and antibiotics
Pediatric / Neonatal Causes	Silver nitrate prophylaxis can cause mild discharge; trauma or infection in older infants	Usually bilateral	Monitor for infection; treat underlying etiology

Special Considerations

Warm compresses can soften crusts and facilitate cleaning of eyelids.
Avoid contaminating the unaffected eye; educate patients on hygiene (no sharing of towels, pillows, eye drops, or cosmetics).
Sterilize ophthalmic instruments after use.
Culture and sensitivity studies may be necessary to identify infectious organisms.

Patient Counseling

Educate on infection control measures to prevent spread.
Advise proper eyelid hygiene and application of lubricants if indicated.
Emphasize adherence to prescribed topical or systemic therapy.

Pediatric Pointers

Prophylactic neonatal eye medications (e.g., silver nitrate) may cause transient irritation.
Eye trauma, infection, or URTI are more common causes of discharge in children.
Hospitalization is indicated for neonates with discharge and fever.

References:

Biswas J, Krishnakumar S, Ahuja S. Manual of Ocular Pathology. New Delhi: Jaypee–Highlights Medical Publishers; 2010.
Eagle RC Jr. Eye Pathology: An Atlas and Text. Philadelphia: Lippincott Williams & Wilkins; 2011.
Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. Philadelphia: Lippincott Williams & Wilkins; 2012.
Holland EJ, Mannis MJ, Lee WB. Ocular Surface Disease: Cornea, Conjunctiva, and Tear Film. London: Elsevier Saunders; 2013.
Onofrey BE, Skorin L Jr, Holdeman NR. Ocular Therapeutics Handbook: A Clinical Manual. Philadelphia: Lippincott–Raven; 2011.
Roy FH. Ocular Differential Diagnosis. Clayton, Panama: Jaypee–Highlights Medical Publishers; 2012.