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The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness.
Bacterial conjunctivitis may cause the production of membranes or pseudomembranes that cover the conjunctiva.
Conjunctivitis, when caused by an infection, is most commonly caused by a viral infection.
Bacterial conjunctivitis causes the rapid onset of conjunctival redness, swelling of the eyelid, and mucopurulent discharge.
Typically, symptoms develop first in one eye, but may spread to the other eye within 2–5 days.
Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy, and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens.
Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.
Pseudomembranes consist of a combination of inflammatory cells and exudates, and are loosely adherent to the conjunctiva, while true membranes are more tightly adherent and cannot be easily peeled away.