Viral Conjunctivitis

Question 1

Aetiology

Answer 1

Adenoviral conjunctivitis is most common form of infective active conjunctivitis in adults. It is caused by adenoviruses (over 50 types) which are highly contagious, ranging from mild to severe. Tends to affect 20-40 y/o.
Common types: EKC (epidemic keratoconjunctivitis, can affect cornea more) and Pharyngoconjunctivitis (more systemic symptoms such as fever, malaise, lymphadenopathy).
Less common types: Enterovirus 70 and Coxsackievirus A24 - can cause haemorrhaging conjunctivitis, Molluscum contagiosum and COVID19

Question 2

Predisposing factors

Answer 2

Flu-like symptoms precede infection
Poor hygiene
Being in crowded environments such as schools, hospitals, clinics.
Eye clinic equipment such as tonometer heads, clinician fingers

Question 3

Symptoms

Answer 3

Redness
Watering
Irritation/discomfort described as burning and grittiness
Mild photophobia
Eyelid swelling
Blurred vision if central cornea affected

Can be unilateral then spreading quickly to other eye, becoming bilateral

Symptoms can develop within 14 days of exposure lasting between 7-21 days.

Systemic malaise

Question 4

Signs

Answer 4

Preauricular lymphadenopathy
Conjunctival hyperaemia (severe) and chemosis
Eyelid oedema
Watery discharge
Pin point SCH
Follicles in tarsal conjunctiva
Pseudomembrane in more severe cases
Cornea - punctate epithelial lesions in first few weeks being replaced with subepithelial infiltrates which can persist for months.

Question 5

Non-pharmacological management

Answer 5

Reassure - self-limiting
Contagious - allowed to take 2 weeks off work.
Cold compresses

Infection control is very important - make sure you clean equipment before and after Px, do not reuse tonoheads.

cease CL wear

Question 6

Pharmacological management

Answer 6

No effective treatment

Ocular lubricants for symptomatic relief.

For severe cases or those with persistent sub epithelial infiltrates for more than 6 weeks, you can issue a less penetrating steroid such as FML used frequently initially then tapering to QDS for 1/12, then TDS for 1/12, then BDS for 4/12.