Viral conjunctivitis: Difference between revisions

 
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==Typical Viral Conjunctivitis==
==Background==
 
===Background===
*Most common cause of infectious conjunctivitis
*Most common cause of infectious conjunctivitis
*Often preceded by URI (usually adenovirus)
*Often preceded by [[URI]] (usually [[adenovirus]])


===Clinical Features===
==Clinical Features==
*Complaint of "red eye" with mild-moderate, watery discharge
[[File:Conjunctivitis.jpg|thumb|Conjunctivitis with limbus sparing]]
[[File:Conjunctivitis disease.jpg|thumb|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
*Usually painless unless there is some degree of keratitis
*Often one eye will be involved initially with other eye involved within days
*Often one eye will be involved initially with other eye involved within days
*Unilateral or bilateral conjunctival injection with perilimbal sparing
*Unilateral or bilateral conjunctival injection with perilimbal sparing
*Chemosis and subconj hemorrhages may be present
*Chemosis and [[subconjunctival hemorrhage]]s may be present
*Preauricular [[lymphadenitis]] (adenovirus)


===Diagnosis===
==Differential Diagnosis==
*Slit Lamp
{{Conjunctivitis DDX}}
 
==Evaluation==
*[[Slit lamp]]
**Follicles on inferior palpebral conjunctival
**Follicles on inferior palpebral conjunctival
**Mild, punctate fluorescein staining of cornea (occasional)
**Mild, punctate fluorescein staining of cornea (occasional)
***Must differentiate from herpetic dendrite
***Must differentiate from herpetic dendrite


===DDx===
{{Clinical diagnosis of conjunctivitis}}
{{Conjunctivitis DDX}}


===Treatment===
==Management==
#Artificial tears 5-6x per day
#Artificial tears 5-6x per day
#Naphazoline/pheniramine 0.025%/0.3% drops 4x daily
#Cold compresses
#Cold compresses
#Consider topical abx if unable to differentiate from bacterial conjunctivitis
#Consider topical antibiotic if unable to differentiate from bacterial conjunctivitis
#Frequent hand-washing (highly contagious)
#Frequent hand-washing (highly contagious)


===Disposition===
==Disposition==
*Follow-up with ophtho if worsening or no improvement in 7 days
*Follow-up with ophtho if worsening or no improvement in 7 days


===See Also===
==See Also==
*[[Conjunctivitis]]
*[[Conjunctivitis]]
*[[Eye algorithms (main)]]


==Epidemic Keratoconjunctivitis==
==References==
===Background===
<references/>
*Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis
*Vision-threatening
*Caused by adenovirus infection that is highly contagious and tends to occur in epidemics
 
===Clinical Features===
*Often preceded by cough, high fever, malaise, myalgias, N/V
*Usual symptoms of viral conjunctivitis plus:
**Foreign body sensation
**Photohobia
**Chemosis
**Papillae of inf palpebral conjunctiva
**Ipsilateral preauricular LAD
 
===Diagnosis===
*Slit Lamp
**Diffuse, superficial keratitis but no corneal ulceration
 
===Treatment===
*Artifical tears
*Cool compresses
*Cycloplegics if photophobia is severe
 
===Disposition===
*Referral to ophthalmologist to confirm dx and decide if pt requires course of steroids
 
==Source==
*Tintinalli
*Mahmood, Narang. Diagnosis and management of acute red eye. Emerg Med Clin N Am 2008;26


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 16:41, 12 March 2021

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

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

See Also

References