Viral Conjunctivitis

Background and aetiology

  • Very common cause of red-eye, commonly caused by adenovirus
  • Risk factors include recent upper respiratory tract infection
  • Usually has a longer course than bacterial conjunctivitis (12-21 days cf 7-10 days) and is highly contagious.
  • Rarer viral causes include herpes simplex (generally more problematic disease- follicular conjunctivitis)), as well as varicella zoster, HIV and influenza.

Presentation

  • History
    • Gritty/uncomfortable eyes (may be one, commonly both)
    • Watery discharge
    • Associated cough/cold
    • Recent association with someone with ‘pink/red eye’
  • Examination
    • Red eye with diffuse conjunctival injection
    • Clear discharge
    • Small, white, lymphoid aggregates may be present on the conjunctiva (viral follicles)
    • Small, focal areas of corneal inflammation with erosions and associated opacities may give rise to pronounced symptoms
    • Lymphadenopathy
  • Special cases
    • Primary ocular HSV mainly affects young children/infants and presents with a red, irritated, watery eye.  Often the eyelid is also affected with multiple vesicular lesions which can be painful too.

Management

  • As with bacterial conjunctivitis, viral conjunctivitis is usually self-limiting and self care (particularly with hygiene and reducing the spread of disease) is all that is recommended.
    • Again, lubricating eye drops may be of benefit.
    • In rare cases where corneal lesions are severe/persistent, steroid drops may be used, but only with ophthalmology supervision, as this carries significant risk of complications (which could ultimately be blinding)

 

 

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