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CONJUNCTIVITIS - VIRAL
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.

Diagnosis

Diagnosis Epidemiology & Predisposing Factors Natural History of Disease Signs & Symptoms
Adenovirus Relatively common & highly contagious. May occur in epidemics. Usually transmitted through direct physical contact w/ infected person or object Self-limited w/ improvement w/ in 5-14 days Abrupt onset bilateral conjunctival injection (one eye may precede the other by a few days) w/ follicular reaction especially of the inferior tarsal conjunctiva, watery discharge, preauricular lymphadenopathy. Occasionally present: petechial or subconjunctival hemorrhage, pseudomembrane or true membrane. 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 Usually subsides in 4-7 days w/o treatment unless there are complications Usually unilateral. Conjunctival injection w/ follicular reaction, watery discharge. Primary infection: Follicular conjunctivitis & lid vesicles (blepharodermatitis). May have pseudomembrane, dendritic keratitis, preauricular lymphadenopathy
Molluscum contagiosum Predominantly older children. Can also occur in immuno-compromised patients Conjunctivitis is associated w/ eyelid lesions which can spontaneously disappear or may last months-years Typically unilateral but can be bilateral. 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

Laboratory Tests

  • Viral cultures & immunodiagnostic tests are not routinely used to establish diagnosis
  • Nucleic acid amplification tests including polymerase chain reaction may be available for certain viruses, but they are not validated for ocular specimens

Wood Lamp Exam

  • Corneal evaluation w/ a Wood lamp examination w/ 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 & absent skin lesions
    • Exam reveals classic corneal dendrites in herpes simplex keratitis
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