Acute hemorrhagic conjunctivitis is a brief viral infection presenting with the sudden onset of ocular signs and symptoms which progress and resolve rapidly. It is typically caused by an enterovirus and was first reported in Ghana. Subsequently, cases have been reported from countries with overcrowding and unhygienic conditions as it is transmitted by the feco-oral route.
Acute hemorrhagic conjunctivitis (AHC) is a contagious and rapidly progressive viral infection reported from poor regions with unhygienic living conditions  . It is caused mainly by enterovirus 70, although coxsackievirus A24 variant, adenoviruses    and Epstein-Barr virus   have also been reported to cause it. Enteroviruses spread easily via the feco-oral route, contaminated hands/ personal items   and vertically between mother and child.
AHC has an incubation period ranging from 12 hours to 2 days and the self-limiting disease can last for up to two week  . Patients present with an acute onset of ocular pain, redness of the eye, photophobia, ocular irritation with excessive lacrimation, and chemosis  . The clinical manifestations depend on the stage of the infection. In the initial stage, the patient has paranasal sinus mucosal inflammation   followed by the appearance of petechia on the conjunctiva. Subsequently, these may form subconjunctival hemorrhages and are accompanied by follicular conjunctivitis, eyelid edema, and induration. In the early part of the AHC infection, the inflammatory response is monocellular and watery and changes to a blood stained response with the progression of the infection . The corneal signs include epithelial keratitis and subepithelial opacities. Occasionally, enterovirus infection has been reported to cause acute lower limb flaccid paralysis, cranial nerve palsies and radiculomyelitis  along with conjunctivitis. Infectious mononucleosis has also been associated with AHC  . AHC symptoms usually resolve in 2 weeks and sequelae are rare.
Enteroviral infection in infants can present as low-grade fever of unspecified etiology and can involve other organs like the myocardium, lungs, central nervous system and the skin.
The clinical course of AHC is very rapid and resolves spontaneously, often without treatment. Hence the workup and laboratory tests have to be performed fast. Clinical suspicion, history and, a detailed ophthalmic examination remain the mainstay of diagnosis.
Studies for rapid viral detection are necessary to identify the causative organism and they are still being improved. Polymerase chain reaction (PCR) assays are supplanting standardized neutralizing antisera assays. Specimens from conjunctival swabs are used to identify the etiology of AHC   . Molecular serotyping with clinical samples has been found to be useful for rapid diagnosis, especially, during epidemics . A real-time (RT) PCR has also provided an early diagnosis in epidemics . In the case of bacterial superinfection of the cornea, microbiological culture and antibiotic sensitivity testing are performed .