Viral conjunctivitis

Background

• Most common cause of infectious conjunctivitis
• Often preceded by URI (usually adenovirus)

Clinical Features

Conjunctivitis with limbus sparing

Viral conjunctitivis lateral view with limbus sparing.

• Complaint of "red eye" with mild-moderate, watery discharge
• Usually painless unless there is some degree of keratitis
• Often one eye will be involved initially with other eye involved within days
• Unilateral or bilateral conjunctival injection with perilimbal sparing
• Chemosis and subconjunctival hemorrhages may be present
• Preauricular lymphadenitis (adenovirus)

Differential Diagnosis

Conjunctivitis Types

• Viral conjunctivitis
  • Epidemic keratoconjunctivitis
  • Herpes zoster ophthalmicus
  • Herpes simplex keratitis
• Bacterial conjunctivitis
  • Gonorrheal conjunctivitis
  • Chlamydia conjunctivitis
• Allergic conjunctivitis
• Caustic keratoconjunctivitis

Evaluation

• Slit lamp
  • Follicles on inferior palpebral conjunctival
  • Mild, punctate fluorescein staining of cornea (occasional)
    • Must differentiate from herpetic dendrite

Clinical diagnosis of conjunctivitis

Conjunctivitis

	Bacterial	Viral	Allergic
Bilateral	50%	25%	Mostly
Discharge	Mucopurulent	Clear, Watery	Cobblestoning, none
Redness	Yes	Yes	Yes
Pruritis	Rarely	Rarely	Yes
Additional	Treatment: Antibiotics	Treatment: Hygiene	Seasonal

Management

1. Artificial tears 5-6x per day
2. Naphazoline/pheniramine 0.025%/0.3% drops 4x daily
3. Cold compresses
4. Consider topical antibiotic if unable to differentiate from bacterial conjunctivitis
5. Frequent hand-washing (highly contagious)

Disposition

• Follow-up with ophtho if worsening or no improvement in 7 days

See Also

• Conjunctivitis