Review Article | | Peer-Reviewed

Evaluation of Conjunctivitis Clinical Practice Guidelines: An Analysis of Quality and Treatment Proposals

Received: 3 January 2025     Accepted: 10 February 2025     Published: 29 December 2025
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Abstract

Introduction: Conjunctivitis is an inflammation of the conjunctiva, commonly caused by bacteria, viruses, or allergens. It represents a significant portion of healthcare visits worldwide and is often self-limiting. However, it can cause considerable discomfort and lead to economic burdens, including medical expenses and lost productivity. Therefore, it is essential to develop and implement clear clinical practice guidelines to ensure appropriate management and avoid unnecessary interventions. Objective: This study aimed to identify and evaluate clinical practice guidelines for the management of acute primary conjunctivitis, focusing on their quality and practical applicability. Methods: A systematic search was conducted across multiple databases to identify relevant clinical practice guidelines. The quality of each guideline was assessed using an established evaluation method that examines six key domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Results: The search identified ten clinical practice guidelines, of which four were considered suitable for recommendation. The guidelines received the lowest scores in applicability and rigor of development, while clarity of presentation and editorial independence received the highest ratings. All guidelines emphasized non-pharmacological therapy as the preferred first-line treatment. Conclusion: Although four guidelines were recommended, their overall quality fell short of expectations, particularly in applicability and long-term intervention follow-up. These findings underscore the need for improvements to enhance the practical implementation and effectiveness of treatment strategies.

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 11, Issue 6)
DOI 10.11648/j.ijcems.20251106.12
Page(s) 102-111
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Conjunctivitis, Clinical Practice Guideline, Management, AGREE II, Analysis

References
[1] Sambursky, R. Acute Conjunctivitis. BMJ Best Practice. 2019, 1–55.
[2] Jacobs, D. S. Conjunctivitis. 2020, 1–24.
[3] Varu, D. M., Rhee, M. K., Akpek, E. K., Amescua, G., Farid, M., Garcia-Ferrer, F. J., et al. Conjunctivitis Preferred Practice Pattern®. Ophthalmology. 2019, 126(1), P94–P169.
[4] Bielory, L., Delgado, L., Katelaris, C. H., Leonardi, A., Rosario, N., & Vichyanoud, P. ICON: Diagnosis and Management of Allergic Conjunctivitis. Ann Allergy Asthma Immunol. 2020, 124(2), 118–134.
[5] DynaMed. Record No. Infectious Conjunctivitis. Ipswich, MA: EBSCO Information Services; 1995, updated 2018. Available from:
[6] Hamrah, P. & Dana, R. Allergic Conjunctivitis: Clinical Manifestations and Diagnosis. 2020, p. 13. Available from:
[7] Galvão, M., Sawada, O. & Rossí, A. Evidence-Based Practice: Theoretical Considerations for Its Implementation in Perioperative Nursing. Rev Lat Am Enfermagem. 2002, 10, 690–695.
[8] Migowski, A. Methodological Guidelines: Preparation of Clinical Guidelines. Rev Bras Cancerol. 2016, 62, 165–166.
[9] Shaneyfelt, T., Smith, M. & Rothwangl, J. Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature. 1999, 281–20.
[10] Djulbegovic, B. & Guyatt, G. H. Progress in Evidence-Based Medicine: A Quarter Century On. Lancet. 2017, 390(10092), 415–423.
[11] Hoffmann-Eßer, W., Siering, U., Neugebauer, E. A., Brockhaus, A. C., Lampert, U. & Eikermann, M. Guideline Appraisal with AGREE II: Systematic Review of the Current Evidence on How Users Handle the 2 Overall Assessments. PLoS ONE. 2017, 12(3), e0174831.
[12] Zeng, X., Zhang, Y., Kwong, J. S., Zhang, C., Li, S., Sun, F., et al. The Methodological Quality Assessment Tools for Preclinical and Clinical Studies, Systematic Review and Meta-Analysis, and Clinical Practice Guideline: A Systematic Review. J Evid Based Med. 2015, 8(1), 2–10.
[13] Duarte, G. S., Delgado, R. M., Costa, J. & Vaz-Carneiro, A. Analysis of the Cochrane Review: Non-Medical Prescribing versus Medical Prescribing for the Management of Acute and Chronic Diseases in Primary and Secondary Health Care. Cochrane Database Syst Rev. 2017, 7–11.
[14] Santana, R. S., de Oliveira Lupatini, E., Zanghelini, F., de March Ronsoni, R., Rech, N. & Leite, S. N. The Different Clinical Guideline Standards in Brazil: High Cost Treatment Diseases versus Poverty-Related Diseases. PLoS One. 2028, 13(10), e0204723.
[15] AGREE Next Steps Consortium. The AGREE II Instrument. 2009. Available from:
[16] Field, M. & Lohr, K. Clinical Practice Guidelines: Directions for a New Program. Institute of Medicine. 1990.
[17] Vaz, J. M., Alves, B. M., Duarte, D. B., Marques, L. A. & Santana, R. S. Quality Appraisal of Existing Guidelines for the Management of Headache Disorders by the AGREE II’s Method. Cephalalgia. 2022, 42(3), 239–249.
[18] Alnamankany, A. & Ashley, P. Assessment of the Quality of Reporting of Randomized Clinical Trials in Paediatric Dentistry: A Comparative Systematic Review. Taibah Univ Med Sci. 2020, 15(1), 1–7.
[19] Anwer, M. A., Al-Fahed, O. B., Arif, S. I., Amer, Y. S., Titi, M. A. & Al-Rukban, M. O. Quality Assessment of Recent Evidence-Based Clinical Practice Guidelines for Management of Type 2 Diabetes Mellitus in Adults Using the AGREE II Instrument. J Eval Clin Pract. 2018, 24(1), 166–172.
[20] Chiappini, E., Bortone, B., Galli, L. & de Martino, M. Guidelines for the Symptomatic Management of Fever in Children: Systematic Review of the Literature and Quality Appraisal with AGREE II. BMJ Open. 2017, 7(7), e015404.
[21] Könsgen, N., Barcot, O., Heß, S., Puljak, L., Goossen, K., Rombey, T., et al. Inter-Review Agreement of Risk-of-Bias Judgments Varied in Cochrane Reviews. J Clin Epidemiol. 2020, 120, 25–32.
[22] Bielory, L., Meltzer, E. O., Nichols, K. K., Melton, R., Thomas, R. K. & Bartlett, J. D. An Algorithm for the Management of Allergic Conjunctivitis. Allergy Asthma Proc. 2013, 34(5), 408–420.
[23] Bielory, B., Brien, T. & Bielory, L. Management of Seasonal Allergic Conjunctivitis: Guide to Therapy. Acta Ophthalmol. 2012, 90(5), 399–407.
[24] Palareti, G., Legnani, C., Cosmi, B., et al. EAACI Guidelines on Allergen Immunotherapy: Allergic Rhinoconjunctivitis (Position Paper). Int J Lab Hematol. 2018, 73(4), 765–798.
[25] Takamura, E., Uchio, E., Ebihara, N., Ohno, S., Ohashi, Y., Okamoto, S., et al. Japanese Guideline for Allergic Conjunctival Diseases. Allergol Int. 2011, 60(2), 191–203.
[26] Azari, A. & Barney, N. Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA. 2013, 310(16), 1721–1729.
[27] Sacchetti, M., Abicca, I., Bruscolini, A., Cavaliere, C., Nebbioso, M. & Lambiase, A. Allergic Conjunctivitis: Current Concepts on Pathogenesis and Management. J Biol Regul Homeost Agents. 2018, 32(1 Suppl. 1), 49–60.
[28] Sánchez-Hernández, M. C., Montero, J., Rondon, C., Benitez del Castillo, J. M., Velázquez, E., Herreras, J. M., et al. Consensus Document on Allergic Conjunctivitis (DECA). J Investig Allergol Clin Immunol. 2015, 25(2), 94–106.
[29] Ventocilla, M. Allergic Conjunctivitis. Medscape. 2019, 1–18.
[30] Hamrah, P. & Dana, R. Allergic Conjunctivitis: Management. Am J Ophthalmol. 1951, 34, 1046.
[31] Hamrah, A. P. & Dana, R. Vernal Keratoconjunctivitis. UpToDate. 2020, 1–21.
Cite This Article
  • APA Style

    Oliveira, S. R., Gomes, S. Y. L., Reis, T. M. D., Silva, D. T. D., Barros, D. S. L., et al. (2025). Evaluation of Conjunctivitis Clinical Practice Guidelines: An Analysis of Quality and Treatment Proposals. International Journal of Clinical and Experimental Medical Sciences, 11(6), 102-111. https://doi.org/10.11648/j.ijcems.20251106.12

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    ACS Style

    Oliveira, S. R.; Gomes, S. Y. L.; Reis, T. M. D.; Silva, D. T. D.; Barros, D. S. L., et al. Evaluation of Conjunctivitis Clinical Practice Guidelines: An Analysis of Quality and Treatment Proposals. Int. J. Clin. Exp. Med. Sci. 2025, 11(6), 102-111. doi: 10.11648/j.ijcems.20251106.12

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    AMA Style

    Oliveira SR, Gomes SYL, Reis TMD, Silva DTD, Barros DSL, et al. Evaluation of Conjunctivitis Clinical Practice Guidelines: An Analysis of Quality and Treatment Proposals. Int J Clin Exp Med Sci. 2025;11(6):102-111. doi: 10.11648/j.ijcems.20251106.12

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  • @article{10.11648/j.ijcems.20251106.12,
      author = {Sara Rodrigues Oliveira and Sarah Yasmin Lucena Gomes and Tiago Marques Dos Reis and Daniel Tenório Da Silva and Débora Santos Lula Barros and Rosângela Maria Gomes and Rodrigo Fonseca Lima and Rafael Santos Santana},
      title = {Evaluation of Conjunctivitis Clinical Practice Guidelines: 
    An Analysis of Quality and Treatment Proposals},
      journal = {International Journal of Clinical and Experimental Medical Sciences},
      volume = {11},
      number = {6},
      pages = {102-111},
      doi = {10.11648/j.ijcems.20251106.12},
      url = {https://doi.org/10.11648/j.ijcems.20251106.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20251106.12},
      abstract = {Introduction: Conjunctivitis is an inflammation of the conjunctiva, commonly caused by bacteria, viruses, or allergens. It represents a significant portion of healthcare visits worldwide and is often self-limiting. However, it can cause considerable discomfort and lead to economic burdens, including medical expenses and lost productivity. Therefore, it is essential to develop and implement clear clinical practice guidelines to ensure appropriate management and avoid unnecessary interventions. Objective: This study aimed to identify and evaluate clinical practice guidelines for the management of acute primary conjunctivitis, focusing on their quality and practical applicability. Methods: A systematic search was conducted across multiple databases to identify relevant clinical practice guidelines. The quality of each guideline was assessed using an established evaluation method that examines six key domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Results: The search identified ten clinical practice guidelines, of which four were considered suitable for recommendation. The guidelines received the lowest scores in applicability and rigor of development, while clarity of presentation and editorial independence received the highest ratings. All guidelines emphasized non-pharmacological therapy as the preferred first-line treatment. Conclusion: Although four guidelines were recommended, their overall quality fell short of expectations, particularly in applicability and long-term intervention follow-up. These findings underscore the need for improvements to enhance the practical implementation and effectiveness of treatment strategies.},
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Evaluation of Conjunctivitis Clinical Practice Guidelines: 
    An Analysis of Quality and Treatment Proposals
    AU  - Sara Rodrigues Oliveira
    AU  - Sarah Yasmin Lucena Gomes
    AU  - Tiago Marques Dos Reis
    AU  - Daniel Tenório Da Silva
    AU  - Débora Santos Lula Barros
    AU  - Rosângela Maria Gomes
    AU  - Rodrigo Fonseca Lima
    AU  - Rafael Santos Santana
    Y1  - 2025/12/29
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ijcems.20251106.12
    DO  - 10.11648/j.ijcems.20251106.12
    T2  - International Journal of Clinical and Experimental Medical Sciences
    JF  - International Journal of Clinical and Experimental Medical Sciences
    JO  - International Journal of Clinical and Experimental Medical Sciences
    SP  - 102
    EP  - 111
    PB  - Science Publishing Group
    SN  - 2469-8032
    UR  - https://doi.org/10.11648/j.ijcems.20251106.12
    AB  - Introduction: Conjunctivitis is an inflammation of the conjunctiva, commonly caused by bacteria, viruses, or allergens. It represents a significant portion of healthcare visits worldwide and is often self-limiting. However, it can cause considerable discomfort and lead to economic burdens, including medical expenses and lost productivity. Therefore, it is essential to develop and implement clear clinical practice guidelines to ensure appropriate management and avoid unnecessary interventions. Objective: This study aimed to identify and evaluate clinical practice guidelines for the management of acute primary conjunctivitis, focusing on their quality and practical applicability. Methods: A systematic search was conducted across multiple databases to identify relevant clinical practice guidelines. The quality of each guideline was assessed using an established evaluation method that examines six key domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Results: The search identified ten clinical practice guidelines, of which four were considered suitable for recommendation. The guidelines received the lowest scores in applicability and rigor of development, while clarity of presentation and editorial independence received the highest ratings. All guidelines emphasized non-pharmacological therapy as the preferred first-line treatment. Conclusion: Although four guidelines were recommended, their overall quality fell short of expectations, particularly in applicability and long-term intervention follow-up. These findings underscore the need for improvements to enhance the practical implementation and effectiveness of treatment strategies.
    VL  - 11
    IS  - 6
    ER  - 

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Author Information
  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil

  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil;Health and Environmental Surveillance Secretariat, Ministry of Health of Brazil, Brasília, Brazil

  • Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil

  • Federal University of the São Francisco Valley, Petrolina, Pernambuco, Brazil

  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil

  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil;Secretariat of Science, Technology, and Innovation and the Economic Industrial Complex of Health, Ministry of Health of Brazil, Brasília, Brazil

  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil

  • Laboratory of Pharmaceutical Evidence and Studies, Faculty of Health Sciences, University of Brasília, Brasília, Brazil

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