Which type of conjunctivitis is the only type of conjunctivitis known to cause (+) preauricular lymphadenopathy?

• A. Epidemic Keratoconjunctivitis
• B. Adult Inclusion Conjunctivitis
• C. Pharyngoconjunctival Fever
• D. Gonococcal Conjunctivitis

Answer: (D)

Preauricular lymph nodes drain the conjunctiva, so a noticeable node swelling signals a robust conjunctival infection. Gonococcal conjunctivitis tends to present as a hyperacute, highly inflammatory infection with copious purulent discharge. That intense inflammatory process elicits a strong lymphatic response, making the preauricular node particularly prominent. This combination—rapid onset, severe purulence, and marked preauricular adenopathy—is the clue that most strongly points to gonococcal involvement among these options.

Other forms can show conjunctival inflammation and sometimes mild node enlargement, but they don’t characteristically produce the same pronounced preauricular lymphadenopathy paired with the hyperacute purulent discharge. For example, adenoviral infections (like epidemic keratoconjunctivitis or pharyngoconjunctival fever) are viral and may involve nodes, but the classic, standout feature is the relief pattern of discharge and corneal involvement, not the exam-level emphasis on a swollen preauricular node. Adult inclusion conjunctivitis presents with mucopurulent discharge and follicles without the same abrupt lymph node response.

So, the strongest clinical cue here is the prominent preauricular lymphadenopathy accompanying a hyperacute, purulent conjunctivitis, which aligns most with gonococcal conjunctivitis and underscores the need for urgent systemic antibiotic management.