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
• Viral conjunctivitis is highly contagious. Patients may return to work or school after discharge from eye(s) has resolved. Advise good hygiene practices and avoid close contact with very old, very young, or other immunocompromised individuals.

See Also

• Conjunctivitis
• Eye algorithms (main)