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 . 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.
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.
Entire Body System
- 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]
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]
Most people who develop bacterial conjunctivitis, also have other eye conditions such as dry eyes or inflammation of the eyelids (blepharitis). [djo.harvard.edu]
Blepharokeratoconjunctivitis is the combination of conjunctivitis with blepharitis and keratitis. [en.wikipedia.org]
Mild itching can also be a feature of blepharitis, dry eyes and, occasionally, bacterial or viral conjunctivitis. [aafp.org]
- 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]
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]
[…] time and, in babies, a blocked tear duct. [visioneyeinstitute.com.au]
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]
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]
- Conjunctival Injection
MAIN OUTCOME MEASURES: Change in six symptoms of conjunctivitis (overall discomfort, itching, foreign body sensation, tearing, redness, and lid swelling) and four signs of conjunctivitis (conjunctival injection, conjunctival chemosis, conjunctival mucus [ncbi.nlm.nih.gov]
This is seen clinically as conjunctival injection with folliculitis, especially on the inferior palpepral conjunctiva. Occasionally, pinpoint subconjunctival hemorrhages may develop. [eyerounds.org]
Physical Examination The patient had right-sided conjunctival injection, her vision was normal, and pupils were equally reactive. [consultant360.com]
- Burning Eyes
Symptoms include redness in the whites of the eyes, watery eyes and a thick discharge that can seal the eyelids shut overnight. Itchy, burning eyes and blurred vision are also common. [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 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  . 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.
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  or antibiotics . 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 .
Viral conjunctivitis typically resolves within 2 to 4 weeks. Patients may have subepithelial infiltrates for a few months which may affect vision.
This eye disease is prevalent worldwide. It affects families, schools, workplaces, healthcare facilities, etc. It especially occurs in the summer .
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 .
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  .
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.
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?
- Eye redness
- Watery discharge
- Eye swelling
- Sticking of the eyelids particularly in the morning
- Itchiness of the eye
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.
- 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.
- O'Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Current Medical Research and Opinion. 2009; 25(8):1953-61.
- Høvding G. Acute bacterial conjunctivitis. Acta Ophthalmologica. 2008; 86(1):5–17.
- 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.
- 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.
- Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Americal Family Physician. 2010; 81(2):137-44.
- Skevaki CL, Galani IE, Pararas MV, Giannopoulou KP, Tsakris A. Treatment of viral conjunctivitis with antiviral drugs. Drugs. 2011; 71(3):331-47.
- Leibowitz HM. The red eye. New England Journal of Medicine. 2000; 343(5):345-51.
- 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.
- 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.