Viral conjunctivitis

Viral conjunctivitis is a highly contagious acute infection of the conjunctiva, usually caused by an adenovirus.

Symptoms include irritation, lacrimation, photophobia, and mucous or purulent discharge. Diagnosis is clinical. The infection is self-limited, but severe cases sometimes require glucocorticoids.

Causes of viral conjunctivitis

Conjunctivitis may accompany the common cold and other systemic viral infections (including measles, as well as chickenpox, rubella, and mumps). Isolated viral conjunctivitis usually results from infection with an adenovirus or enterovirus.

Epidemic keratoconjunctivitis usually results from adenoviruses of the Ad serotypes 5, 8, 11, 13, 19, and 37. Pharyngoconjunctival fever usually results from Ad serotypes 3, 4, and 7. Outbreaks of acute hemorrhagic conjunctivitis associated with enterovirus type 70 infection occur in Africa and Asia.

With common viral infections (measles, mumps, rubella, flu) viral conjunctivitis also often occurs.

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Symptoms of viral conjunctivitis

After an incubation period of 5-12 days, conjunctival hyperemia and serous discharge from one eye quickly spread to the other. Follicles appear on the conjunctiva of the eyelids. The preauricular lymph nodes often enlarge and become painful. Many patients have had a history of contact with patients with conjunctivitis.

In severe adenoviral conjunctivitis, patients have severe photophobia and foreign body sensation. Fibrin pseudomembranes, inflammatory cells on the conjunctival cartilage, and/or focal corneal inflammation may reduce vision. Even after recovery from conjunctivitis, residual subepithelial corneal opacities (multiple, coin-shaped, 0.5-1.0 mm in diameter) may be visible on slit lamp examination for up to two years. Corneal opacities sometimes lead to decreased vision and severe photophobia.

Measles conjunctivitis

Measles most often affects preschool children. The incubation period is 9-11 days. The temperature rises to subfebrile numbers. There is a rash on the skin of the body, spots on the mucous membrane of the cheeks, on the conjunctiva of the eyelids. Symptoms of conjunctival irritation and superficial keratitis may be expressed. Since measles reduces the body's resistance, other infections may join (tuberculosis, allergic herpetic conjunctivitis). Against the background of measles and other infections, myopia, strabismus progress, blepharitis, uveitis, optic neuritis, blindness may join. Measles gives results in a rough corneal leucorrhoea, sometimes with staphyloma.

Treatment is symptomatic: combating secondary infection, administering an anti-measles drug - globulin - 1.5-3.0 intramuscularly, 2-3 injections with an interval of 2-3 days.

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Mumps conjunctivitis

Mumps - against the background of elevated temperature, the salivary gland increases in size, and the following develops:

• dacryoadenitis (acute orbital pain, swelling, etc.);
• orchitis, pancreatitis, meningitis;
• optic neuritis is possible;
• conjunctivitis, keratitis, scleritis.

There is no specific (parotic) conjunctivitis. It is usually caused by a secondary infection.

Prevention - isolation of the patient, symptomatic treatment.

Influenza conjunctivitis

Influenza conjunctivitis is the most polymorphic, with little discharge and conjunctival hyperemia. Bacterial and fungal infections may join in. Influenza conjunctivitis may be complicated by keratitis, uveitis, and neuroretinitis.

Treatment of influenza conjunctivitis. Theobrofen - 0.5% ointment, interferon, mydriatics.

Conjunctivitis caused by molluscum contagiosum

Molluscum is a filterable virus that causes characteristic lesions on the skin and, less frequently, on the mucous membranes. It is spread by direct contact and occurs primarily in childhood. Molluscum is also often found in patients with AIDS. With ocular manifestations of molluscum, other parts of the patient's body may also be affected.

Symptoms of conjunctivitis caused by molluscum contagiosum

1. At the edge of the eyelid, a small, pale nodule, often with a waxy sheen, is formed, having an umbilicated retraction.
2. The lesion may be missed if it is atypical in appearance or located some distance from the eyelid margin.
3. The discharge is usually moderate and mucus-like.
4. Follicular reaction of the conjunctiva - on the side of the affected eyelid.
5. Rarely, in patients with immune deficiency, molluscum nodules may appear on the bulbar conjunctiva.
6. With prolonged progression, epithelial keratitis may develop, which, if left untreated, leads to the formation of pannus.

Treatment of conjunctivitis caused by molluscum contagiosum involves destruction of the affected area of the eyelid by expression, excision, cryotherapy or cauterization.

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Diagnosis of viral conjunctivitis

The diagnosis of viral conjunctivitis is usually made clinically; special tissue cultures are needed to perform cultures. Secondary bacterial infection is rare. However, if symptoms are consistent with bacterial conjunctivitis (e.g., purulent discharge), smears from the eye should be examined microscopically and cultured for bacterial flora.

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Treatment of viral conjunctivitis

Viral conjunctivitis is highly contagious, so precautions to prevent transmission (as above) should be taken. Children should generally be kept out of school until they have recovered.

Viral conjunctivitis may resolve spontaneously, lasting up to one week in uncomplicated cases and up to three weeks in severe cases. They require only cold compresses for symptomatic relief. However, patients with severe photophobia or those with decreased vision may benefit from glucocorticoids (eg, 1% prednisolone acetate every 6-8 hours). Keratitis caused by the herpes simplex virus must first be excluded, as glucocorticoids may provoke an exacerbation of this.