Viral conjunctivitis
Background
- Most common cause of infectious conjunctivitis in adults[1]
- Often preceded by URI (usually adenovirus)
Conjunctivitis Types
Clinical Features
- 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
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Bilateral red eyes
- Painful
- Painless
Evaluation
- Slit lamp
- Follicles on inferior palpebral conjunctival
- Mild, punctate fluorescein staining of cornea (occasional)
- Must differentiate from herpetic dendrite
Clinical diagnosis of conjunctivitis^
| Bacterial | Viral | Allergic | |
|---|---|---|---|
| Bilateral | 50% | 25% | Mostly |
| Discharge | Mucopurulent | Clear, Watery | Cobblestoning, none |
| Redness | Yes | Yes | Yes |
| Pruritis | Rarely | Rarely | Yes |
| Increased Likelihood | Presence of mucopurulent discharge; otitis media | Concomitant pharyngitis; an enlarged preauricular node; contact with another person with red eye | NA |
| Additional | Treatment: Antibiotics | Treatment: Hygiene | Seasonal |
Management
- Artificial tears 5-6x per day
- Naphazoline/pheniramine 0.025%/0.3% drops 4x daily
- Cold compresses
- Consider topical antibiotic if unable to differentiate from bacterial conjunctivitis
- Frequent hand-washing (highly contagious)
Disposition
- Follow-up with ophtho if worsening or no improvement in 7 days
- Viral conjunctivitis is highly contagious. Patients may return to work or school after discharge from eye(s) has resolved. Advise good hygiene practices and avoid close contact with very old, very young, or other immunocompromised individuals.
See Also
References
- ↑ Johnson D, et al. "Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection" The Rational Clinical Examination Systematic Review. JAMA.2022;327(22):2231-2237. doi:10.1001/jama.2022.7687