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Viral Conjunctivitis

Viral conjunctivitis is a benign yet highly contagious eye condition that usually resolves spontaneously.


The clinical presentation includes conjunctival hyperemia, watery discharge, swelling, sticking of the eyelids, and pruritus of the affected eye(s). Additionally, they may exhibit enlarged and tender preauricular lymph nodes, which is prevalent in patients with viral conjunctivitis [2]. Severe episodes involving the cornea will result in photophobia and foreign body sensation. Moreover, corneal opacities and pseudomembrane formation cause visual impairment.

This is highly contagious and usually follows contact with an infected person. It can also develop after a recent upper respiratory infection. There may be a simultaneous infection of both eyes or a subsequent involvement of the other eye a few days later.

Eye exam

Inspection of the eye includes findings such as redness, edematous eyelid, watery discharge, subconjunctival hemorrhages, punctuate keratopathy, and the presence of pseudomembrane. Lymphadenopathy is another common feature. Furthermore, microcysts on the cornea are indicative of viral conjunctivitis.

Cat Scratch
  • HSV Chlamydia Bacterial Conjunctivitis (including GC in neonate) Toxic conjunctivitis (molluscum) Allergic conjunctivitis Atopic conjunctivitis Contact Lens related complications Blepharoconjunctivitis Foreign body Parinaud’s oculoglandular syndrome Cat-scratch[eyerounds.org]
Recent Viral Illness
  • The clinician should obtain full details about the onset, timing, symptoms, history of recent viral illnesses, and possible exposure. Most cases do not warrant laboratory testing as testing can take time, can be costly, and inconvenient.[symptoma.com]
Skin Lesion
  • For conjunctivitis associated with molluscum contagiosum, disease will persist until the skin lesion is treated. Removal of the central core of the lesion or inducement of bleeding within the lesion usually is enough to cure the infection.[emedicine.medscape.com]
  • Without treatment, and usually even with it, skin lesions will erupt in the dermatome of the affected nerve(s). Early treatment lessens the severity and duration of the infection.[reviewofoptometry.com]
Skin Papule
  • Molluscum contagiosum is treated by physicial removal of the skin papule /s. Severe cases may require hospitalisation for systemic and topical treatments. Patients should be educated about hygiene measures to reduce the spread of the infection .[dermnetnz.org]
Red Eye
  • Red eye (OS OD) with crusting on the lashes. Figure 2: Slit Lamp Photos OS Crusting on the lashes. Conjunctival injection with a follicular conjunctivitis. Figure 3: Slit Lamp Photos OS Ciliary flush along the corneal limbus.[eyerounds.org]
  • When a patient comes into the emergency department complaining of red eyes, crusting, and discharge, they are almost always prescribed antibiotic drops.[clinicaladvisor.com]
  • Common symptoms of viral conjunctivitis include red eyes, a watery clear discharge and a feeling of something scratching your eye (what we call a “foreign body sensation”).[bendigoufs.com.au]
  • Viral infection of conjunctiva Commonest reason for acute unilateral red eye Usually caused by adenovirus Usually preceding or concurrent symptoms of upper respiratory infection Resolves spontaneously within week without leaving relics Sometimes easily[kellogg.umich.edu]
  • Herpes simplex infection can also cause keratitis , blepharitis, and iritis. It is associated with enlarged and tender preauricular lymph node. The presentation of other viral forms of conjunctivitis depends on the specific virus.[dermnetnz.org]
  • Complications Occasionally the disease may be complicated by • marginal corneal ulcer, • superficial keratitis, • blepharitis or dacryocystitis 35.[slideshare.net]
  • Most people who develop bacterial conjunctivitis, also have other eye conditions such as dry eyes or inflammation of the eyelids (blepharitis).[djo.harvard.edu]
Excessive Tearing
  • When infected with AHC, patients will experience painful, red eyes, swelling of the conjunctival tissue, and frequent mucus discharge from the eyes accompanied by excessive tearing and subconjunctival hemorrhaging.[en.wikipedia.org]
  • The most common reported symptom was excessive tearing of the eye or epiphora (92.9%) followed by conjunctival hyperemia (65.8%), photophobia (54.1%), subconjunctival hemorrhage (48.1%), eye pain (47.5%), and palpebral chemosis (36.4%).[djo.harvard.edu]
  • Allergic Itching, redness, and excessive tearing, usually of both eyes. Chemical Red, watery eyes, especially after swimming in chlorinated water. Immune mediated, such as that related to a systemic disease like Kawasaki disease .[healthychildren.org]
  • Book a consultation Symptoms One or both eyes may be affected and symptoms can include: Redness Itchiness A gritty, uncomfortable feeling A discharge, which can form a crust during the night and make it difficult to open the eye in the morning Excessive[visioneyeinstitute.com.au]
  • Signs and symptoms of conjunctivitis If your child has conjunctivitis, they may have: a red or pink eye (or both eyes) redness behind the eyelid swelling of the eyelids, making them appear puffy excessive tears a yellow-green discharge from the eye which[rch.org.au]
Burning Eyes
  • Itchy, burning eyes and blurred vision are also common. The virus that causes pink eye can also cause cold-like symptoms, bronchitis, pneumonia and diarrhea. For viral pink eye, you just have to let it run its course.[wilx.com]
  • Burning eyes – Irresistible irritation with itching and burning sensation in the eyes is typical characteristic of pinkeye.[thehealthsite.com]
  • If you have pink eye, you might also: have tears have a discharge , usually yellow or green, and crusty lashes, usually worse on waking have itchy or burning eyes be sensitive to light Check your symptoms with healthdirect’s Symptom Checker to get advice[healthdirect.gov.au]
  • Green or white discharge from the eye Itchy eyes Burning eyes Blurred vision More sensitive to light Swollen lymph nodes (often from a viral infection ) When to Call Your Doctor Make the call if: There’s a lot of yellow or green discharge from your eye[webmd.com]
Unilateral Red Eye
  • Viral infection of conjunctiva Commonest reason for acute unilateral red eye Usually caused by adenovirus Usually preceding or concurrent symptoms of upper respiratory infection Resolves spontaneously within week without leaving relics Sometimes easily[kellogg.umich.edu]
  • The importance of early recognition and appropriate treatment of dysautonomias is emphasised. The probable aetiopathogenesis of the neurological complications including dysautonomias is discussed.[ncbi.nlm.nih.gov]


The diagnosis is confirmed through assessment of the clinical presentation and an ocular exam. The clinician should obtain full details about the onset, timing, symptoms, history of recent viral illnesses, and possible exposure.

Most cases do not warrant laboratory testing as testing can take time, can be costly, and inconvenient [4] [5]. Severe cases where there is suspicion of orbital cellulitis warrant a polymerase chain reaction (PCR) test and possibly other immunologic studies. Additional diagnostic tools such a slit lamp test are performed in patients with photophobia.

Bartonella Henselae
Lymphocytic Infiltrate
  • In EKC, topical corticosteroids help reduce lymphocytic infiltration and hasten the recovery of vision and comfort secondary to corneal SEI. However, steroids have no beneficial therapeutic effect on the ultimate clinical outcome.[optometricmanagement.com]


The therapeutic approach includes supportive measures such as the use of cold compresses, artificial tears, topical antihistamines, and topical vasoconstrictors although the latter two are not typically beneficial. There is no indication for antivirals [6] or antibiotics [7]. Patients with visual defects or photophobia may be treated with topical steroids.

Due to the high risk of transmission, children and adults should not attend school or work until the infection has resolved. If symptoms persist beyond 7 to 10 days, patients will require an ophthalmology consult [8].


Viral conjunctivitis typically resolves within 2 to 4 weeks. Patients may have subepithelial infiltrates for a few months which may affect vision.


Most cases of conjunctivitis in all ages are caused by viruses [1], of which adenovirus accounts for up to 90% of cases [2]. Other implicated viruses include herpes simplex virus (HSV), varicella-zoster virus (VZV), picornavirus, poxvirus, HIV, etc.


This eye disease is prevalent worldwide. It affects families, schools, workplaces, healthcare facilities, etc. It especially occurs in the summer [3].

Sex distribution
Age distribution


This contagious condition is transmitted through contact with contaminated hands, objects, or even respiratory droplets. The communicable period ranges from 10 days to 2 weeks [3].


Since this can spread rapidly in schools, workplaces, and other facilities, precautions must be implemented. Proper handwashing and other hygiene practices should be undertaken. Also, clinics should disinfect contaminated instruments and isolate patients in order to prevent transmission [9] [10].


Viral conjunctivitis is very common as it is responsible for the majority of cases of infectious conjunctivitis. The clinical picture is variable but usually features unilateral or bilateral eye involvement with redness, watery discharge, and swelling. This self-limiting disease does not warrant treatment and typically resolves in 2 to 4 weeks. All affected individuals should practice good hygiene and avoid attending school and workplaces.

Patient Information

What is viral conjunctivitis?

This is a condition known as "pink eye." It is very contagious and can be easily spread in schools, workplaces, and other locations through contaminated hands, objects, or air droplets.

What are the signs and symptoms?

How is it diagnosed?

Doctors diagnose this disease by asking about the history and symptoms as well as performing an eye exam.

How is it treated?

The goal is to provide symptom relief with:

Patients must avoid going to school or work. They should also practice handwashing and good hygiene.



  1. Fitch CP, Rapoza PA, Owens S, et al. Epidemiology and diagnosis of acute conjunctivitis at an inner-city hospital. Ophthalmology. 1989; 96(8):1215–1220.
  2. O'Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Current Medical Research and Opinion. 2009; 25(8):1953-61.
  3. Høvding G. Acute bacterial conjunctivitis. Acta Ophthalmologica. 2008; 86(1):5–17.
  4. Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. American Journal of Medicine and Science. 2008; 336(3):254-64.
  5. Kaneko H, Maruko I, Iida T, Ohguchi T, Aoki K, Ohno S, et al. The possibility of human adenovirus detection from the conjunctiva in asymptomatic cases during nosocomial infection. Cornea. 2008; 27(5):527-30.
  6. Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Americal Family Physician. 2010; 81(2):137-44.
  7. Skevaki CL, Galani IE, Pararas MV, Giannopoulou KP, Tsakris A. Treatment of viral conjunctivitis with antiviral drugs. Drugs. 2011; 71(3):331-47.
  8. Leibowitz HM. The red eye. New England Journal of Medicine. 2000; 343(5):345-51.
  9. Azar MJ, Dhaliwal DK, Bower KS, Kowalski RP, Gordon YJ. Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis. American Journal of Ophthalmology. 1996; 121(6):711-2.
  10. Warren D, Nelson KE, Farrar JA, Hurwitz E, Hierholzer J, Ford E, Anderson LJ. A large outbreak of epidemic keratoconjunctivitis: problems in controlling nosocomial spread. Journal of Infectious Diseases. 1989; 160(6):938-43.

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Last updated: 2019-07-11 21:08