Visual acuity is usually normal in conjunctivitis. The conjunctiva appears hyperaemic and there can be evidence of purulent discharge on the lid margins, causing matting together of the eyelashes. The redness of the conjunctiva extends to the conjunctival fornices and is usually less marked at the limbus. When a rim of dilated vessels is seen around the cornea, the examiner must suspect a more serious inflammatory reaction within the eye. Apart from being red to a greater or lesser degree,the eyes also tend to water, but a dry eye might lead one to suspect conjunctivitis results from inadequate tear secretion. Drooping of one or both upper lids is a feature of some types of viral conjunctivitis and this can be accompanied by enlargement of the preauricular lymph nodes. The ophthalmologist should train himself or herself to feel for the preauricular node as a routine part of the examination of such a case. Closer inspection of the conjunctiva might reveal numerous small papillae, giving the surface a velvety look, or the papillae may be quite large. Giant papillae under the upper lids are a feature of spring catarrh, a form of allergic conjunctivitis. Close inspection of the conjunctiva might also reveal follicles or lymphoid hyperplasia. Being deep to the epithelium, they are small, pale, raised nodules and are commonly seen in viral conjunctivitis. Follicles under the upper lids are especially characteristic of trachoma.
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