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)
    1. Viral Conjunctivitis accounts for 55 to 80% of Conjunctivitis cases in adults
    2. Bacterial Conjunctivitis is more common in children (up to 71% 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 (esp. Adenovirus)
    1. Chlorine does not eliminate Adenovirus
  • Causes
  1. Adenovirus (most common)
    1. Highly contagious (survives up to 28 days, 30% transmission rate)
    2. Transmitted via fomites (e.g. fingers, cosmetics) and swimming pools
  2. Epidemic Keratoconjunctivitis (more severe, Lymphadenopathy)
  3. Enterovirus
  4. Coxsackievirus
  5. Varicella Zoster Virus (Herpes Ophthalmicus)
  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
  2. See Herpes Ophthalmicus
  • 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
    1. Hosts shed Adenovirus for 10 to 14 days
    2. Avoid exposing others for at least 7 days, and at least until Red Eye and tearing resolves
  5. Topical lubricant eye drops (Methylcellulose, Refresh Tears) or artificial tears
  6. Remove Contact Lens and do not wear again until Conjunctivitis resolves
  7. Avoid Topical Corticosteroids (prolonged viral shedding, Glaucoma risk)
  8. Antibiotic not indicated in Viral Conjunctivitis
    1. See Bacterial Conjunctivitis
    2. Risk of Antibiotic Resistance, transmission of Viral Conjunctivitis to contralateral eye, chemical Conjunctivitis
  • Prevention
  1. Frequent Hand Washing
  2. Do not share towels, pillowcases or eye makeup
  3. Throw away used Contact Lenses and their case
  4. Throw away used eye makeup
  5. Avoid touching your face
  6. 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)
    1. Return if failed resolution by 2 to 3 weeks
  • 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]
  3. Winters (2024) Am Fam Physician 110(2):134-44 [PubMed]