Spread of organisms to the ocular surface can occur through a variety of modes, however, direct contamination by the fingers is the most common one. Most of the isolates are part of the normal nasopharyngeal bacterial flora. Organisms can also be spread as airborne droplets, initiated by sneezing and coughing, or by contact with fomites.

Propionibacterium acnes and Peptostreptococcus spp. are present in the conjunctival sac of uninflamed eyes (8). The presence of anaerobes in the normal conjunctival sac does not exclude their ability to become pathogenic under the right circumstances. This can occur when injuries, foreign bodies, and underlying noninfectious diseases favor the establishment of conjunctival infections, thus allowing for the resident organisms to become pathogenic.

Oral flora anaerobes can be introduced to the conjunctivae by wetting contact lens with saliva.

Typically, the palpebral conjunctiva is more inflamed than the bulbar, and the area around the cornea is spared. A bacterial etiology is suspected when severe conjunctivitis is present, and many polymorphonuclear leukocytes are found in conjunctival swab specimens. Severe infection, copious exudate, and matting of the eyelids are more likely to occur with bacterial or chlamydial infection than with viral infection. Preauricular lymphadenitis is generally associated with viral infections.

Conjunctivitis associated with anaerobes is indistinguishable from inflammation caused by other bacteria, although patients wearing contact lenses may be at higher risk of developing infections caused by these organisms. The presence of lymphocytes suggests viral infection, eosinophils and basophils suggest an allergic etiology, and intranuclear inclusions implicate herpes or adenoviruses. Conjunctival scraping can be helpful when they contain conjunctival epithelial cells that may harbor intracellular pathogens. Gram and giemsa stains and aerobic and anaerobic cultures are necessary for correct diagnosis.

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