conjunctivitis%20-%20viral
CONJUNCTIVITIS - VIRAL
Treatment Guideline Chart
Viral conjunctivitis is the inflammation of the conjunctiva of viral etiology.
Signs and symptoms include unilateral or bilateral eye redness, foreign body sensation and follicular conjunctival reaction.
It may be caused by adenovirus, herpes simplex or molluscum contagiosum.

Conjunctivitis%20-%20viral Diagnosis

History

  • Questions regarding signs and symptoms (eg duration, exacerbating factors, character of the discharge), exposure to an infected individual, recent surgery or trauma, and use of topical or systemic medications should be elicited
  • Includes previous episodes of conjunctivitis or ophthalmic surgery or history of ocular diseases
  • Inquire about the individual’s immune status or history of systemic diseases

Ophthalmic Examination

  • Initial eye examination includes external examination, visual acuity and slit-lamp biomicroscopy

Diagnosis

Diagnosis Epidemiology and Predisposing Factors Natural History of Disease Signs and Symptoms
Adenovirus

• Relatively common and highly contagious
• May occur in epidemics
• Usually transmitted through direct physical contact with infected person or object

Self-limited with improvement within 5-14 days • Abrupt onset, unilateral or bilateral conjunctival injection (one eye may precede the other by a few days) with follicular reaction especially of the inferior tarsal conjunctiva, watery discharge, chemosis, eyelid swelling and erythema
• Distinctive signs: Preauricular lymphadenopathy, petechial or subconjunctival hemorrhage, pseudomembrane or true membrane or corneal epithelial defect
• Superficial multifocal punctate keratitis may occur followed by subepithelial opacities
• Filamentary keratitis may occur in patients who maintain their lids closed to minimize ocular discomfort
Herpes simplex • Primary infection from infected individual
• Reactivation of prior infection triggered by stress, other viral or febrile illness, surgery or trauma
Usually subsides in 4-7 days without treatment unless there are complications • Usually unilateral but can be bilateral in atopic or immunocompromised patients
• Conjunctival injection with follicular reaction and watery discharge
• Primary infection: Follicular conjunctivitis and lid vesicles(blepharodermatitis)
• Distinctive signs: Vesicular rash, lid ulceration, pseudomembrane, dendritic keratitis, or preauricular lymphadenopathy
Molluscum contagiosum • Predominantly older children and young adults
• Can also occur inimmunocompromised patients
Conjunctivitis is associated with eyelid lesions which can spontaneously disappear or may last for months to years • Typically unilateral but can be bilateral
• Distinctive signs: Single or multiple shiny, dome shaped umbilicated lesions on the eyelid or lid margin
• Mild to severe follicular reaction, punctate epithelial keratitis
• May have corneal pannus in long standing disease
Varicella zoster • Acute or exposure to chicken pox
• Recurrent varicella zoster virus (VZV)(shingles)
Usually subsides in a few days and vesicles may format at the limbus • Usually unilateral or bilateral
• Conjunctival infection with follicular reaction and watery discharge
• Punctate keratitis in primary disease and punctuate or dendritic keratitis in recurrent disease
• Distinctive signs: Vesicular dermatomal rash, lid ulceration, pleomorphic or nonexcavated pseudodendritic epithelial keratitis

Diagnostic Tests

  • Viral cultures and immunodiagnostic tests are not routinely used to establish diagnosis but may help in preventing misdiagnosis and unnecessary antibiotic use
    • Rapid immunodiagnostic test using antigen detection may be used for adenovirus and herpes simplex virus (HSV) conjunctivitis
  • Nucleic acid amplification tests including polymerase chain reaction (PCR) may be available for certain viruses, but they are not validated for ocular specimens

Wood Lamp Exam

  • Corneal evaluation with a wood lamp examination with fluorescein staining helps detect subtle findings of herpes simplex keratitis as herpes simplex keratitis may have the same presentation as adenoviral conjunctivitis, eg watery discharge and absent skin lesions
    • Exam reveals classic corneal dendrites in herpes simplex keratitis
  • Lesions that are highly branched without end bulbs is seen in VZV keratitis
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