Conjunctiva

Viral Conjunctivitis

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Viral Conjunctivitis, Pink Eye, Adenopharyngitis Associated Conjunctivitis

  • See Also
  1. Epidemic Keratoconjunctivitis
  2. Herpes Simplex Conjunctivitis
  • Epidemiology
  1. Viral Conjunctivitis is most common Conjunctivitis cause (80% of cases)
  2. Typically spread by contaminated hands
  3. Viral sources can survive on fomites for up to 72 hours
  4. Common cause of Swimming Pool Conjunctivitis
    1. Chlorine does not eliminate the virus
  • Causes
  1. Adenovirus (most common)
  2. Epidemic Keratoconjunctivitis (more severe, Lymphadenopathy)
  3. Enterovirus
  4. Coxsackievirus
  5. Varicella Zoster Virus
  6. Epstein-Barr Virus (EBV, Mononucleosis)
  7. Herpes Simplex Virus (Herpes Keratitis)
  8. Influenza
  • Symptoms
  1. Mild watery Eye Discharge or tearing
  2. Insidious onset over 36 hours
  3. Mild eye burning to no pain (eye may feel gritty)
  4. Mild eye itch
  5. Diffuse Conjunctival Hyperemia
  6. Unilateral initially and spreads to opposite eye within 1-2 days
  7. Associated symptoms
    1. Upper Respiratory Infection
    2. Severe Pharyngitis with some infections (e.g. coxsackievirus, Mononucleosis)
  • Signs
  1. Marked Conjunctival erythema
  2. Epiphora (Eye tearing)
  3. Preauricular Lymphadenopathy (anterior to tragus)
    1. Highly suggestive of Viral Conjunctivitis (especially Adenovirus)
  4. Mild palpebral Conjunctival follicular response
  5. Multiple small subepithelial Corneal infiltrates (severe cases)
  6. Fever
  • Differential Diagnosis
  1. Epidemic Keratoconjunctivitis
  2. Bacterial Conjunctivitis
  • Precautions
  • Red Flags
  1. See Conjunctivitis
  • Management
  1. Conditions requiring urgent ophthalmology referral
    1. Herpetic Conjunctivitis
    2. Epidemic Keratoconjunctivitis
  2. Warm soaks to keep lids and lashes free of debris
  3. Cool compresses may be soothing
  4. Practice good hygiene to prevent contagious spread
  5. Topical lubricant (Methylcellulose) or artificial tears
  6. Antibiotic not indicated in Viral Conjunctivitis
    1. See Bacterial Conjunctivitis
  • Prevention
  1. Frequent Hand Washing
  2. Do not share towels
  3. Wipe contaminated surfaces with bleach
    1. Adenovirus survives on surfaces for 72 hours
  • Course
  1. Eye discomfort may persist for up to 10 days
  2. Infectious while excessive eye watering continues (typically 10-14 days)
  • Resources (Include Patient Education)
  1. See Conjunctivitis Resources
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]