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Ophthalmology – Acute Viral Conjunctivitis
Acute viral conjunctivitis is a very common inflammation of the conjunctiva, most frequently caused by adenovirus, which accounts for the majority of cases worldwide. It affects individuals of all ages and is highly contagious, often spreading rapidly in households, schools, and crowded environments. Viral conjunctivitis represents 20–70% of all acute conjunctivitis cases, making it the most common overall cause.
Patients typically present with a red eye that begins in one eye and spreads to the other within a few days, accompanied by watery or mucoid discharge, irritation, and tearing. A history of recent upper respiratory infection or contact with an infected person is common. Compared to bacterial conjunctivitis, the discharge is more watery rather than purulent. Many patients also develop preauricular lymphadenopathy, which is a helpful distinguishing feature.
On examination, findings include conjunctival injection, follicular reaction on the palpebral conjunctiva, and sometimes microhemorrhages. In more severe forms such as epidemic keratoconjunctivitis (EKC), patients may develop pseudomembranes and later subepithelial infiltrates in the cornea, which can cause decreased vision and photophobia. These infiltrates typically appear 7–10 days after onset. Other viral forms include pharyngoconjunctival fever (PCF) and acute hemorrhagic conjunctivitis.
Diagnosis is primarily clinical, although rapid point-of-care adenovirus testing is available and can confirm the diagnosis within minutes. More advanced tests such as PCR or viral culture are rarely needed in routine cases. It is important to distinguish viral conjunctivitis from bacterial, allergic, or more serious ocular conditions.
Treatment is mainly supportive, as there are no FDA-approved antiviral agents for adenoviral conjunctivitis. Recommended measures include frequent use of preservative-free artificial tears, cold compresses, and strict hygiene practices such as handwashing and avoiding shared towels. Topical antihistamines may help with itching. In cases caused by herpes simplex virus (HSV), antiviral therapy such as topical ganciclovir or trifluridine is required.
Topical steroids may be used cautiously in severe cases with pseudomembranes or visually significant subepithelial infiltrates, but they should be avoided in mild disease because they can prolong viral shedding and worsen infection.
The prognosis is generally excellent, with most patients recovering spontaneously within 1–2 weeks. However, some patients—especially those with EKC—may develop persistent subepithelial infiltrates or chronic dry eye symptoms, which can last for weeks to months. Patients should be educated about the highly contagious nature of the disease and advised that antibiotics are ineffective unless a secondary bacterial infection is present.
Acute viral conjunctivitis is a very common inflammation of the conjunctiva, most frequently caused by adenovirus, which accounts for the majority of cases worldwide. It affects individuals of all ages and is highly contagious, often spreading rapidly in households, schools, and crowded environments. Viral conjunctivitis represents 20–70% of all acute conjunctivitis cases, making it the most common overall cause.
Patients typically present with a red eye that begins in one eye and spreads to the other within a few days, accompanied by watery or mucoid discharge, irritation, and tearing. A history of recent upper respiratory infection or contact with an infected person is common. Compared to bacterial conjunctivitis, the discharge is more watery rather than purulent. Many patients also develop preauricular lymphadenopathy, which is a helpful distinguishing feature.
On examination, findings include conjunctival injection, follicular reaction on the palpebral conjunctiva, and sometimes microhemorrhages. In more severe forms such as epidemic keratoconjunctivitis (EKC), patients may develop pseudomembranes and later subepithelial infiltrates in the cornea, which can cause decreased vision and photophobia. These infiltrates typically appear 7–10 days after onset. Other viral forms include pharyngoconjunctival fever (PCF) and acute hemorrhagic conjunctivitis.
Diagnosis is primarily clinical, although rapid point-of-care adenovirus testing is available and can confirm the diagnosis within minutes. More advanced tests such as PCR or viral culture are rarely needed in routine cases. It is important to distinguish viral conjunctivitis from bacterial, allergic, or more serious ocular conditions.
Treatment is mainly supportive, as there are no FDA-approved antiviral agents for adenoviral conjunctivitis. Recommended measures include frequent use of preservative-free artificial tears, cold compresses, and strict hygiene practices such as handwashing and avoiding shared towels. Topical antihistamines may help with itching. In cases caused by herpes simplex virus (HSV), antiviral therapy such as topical ganciclovir or trifluridine is required.
Topical steroids may be used cautiously in severe cases with pseudomembranes or visually significant subepithelial infiltrates, but they should be avoided in mild disease because they can prolong viral shedding and worsen infection.
The prognosis is generally excellent, with most patients recovering spontaneously within 1–2 weeks. However, some patients—especially those with EKC—may develop persistent subepithelial infiltrates or chronic dry eye symptoms, which can last for weeks to months. Patients should be educated about the highly contagious nature of the disease and advised that antibiotics are ineffective unless a secondary bacterial infection is present.
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