Viral Conjunctivitis in Adults

Viral conjunctivitis in adults is an acute, contagious infection of the conjunctiva, most often by adenovirus. It spreads by hand contact, contaminated surfaces, shared towels and ophthalmic instruments.

• Epidemic keratoconjunctivitis (adenovirus types 8, 19 and 37) involves the cornea.
• Other causes are enterovirus (acute haemorrhagic conjunctivitis), coxsackievirus, herpes simplex virus and varicella zoster virus.
• It follows an upper respiratory infection in many patients.

Red, watery, gritty eye, usually starting in one eye and spreading to the other within days, with clear or mucoid discharge, a tender pre auricular node, lid swelling and photophobia in corneal disease.

• Symptoms peak at 3 to 5 days and last 1 to 3 weeks.
• Differential diagnosis: bacterial conjunctivitis, allergic conjunctivitis, herpes simplex keratitis, herpes zoster ophthalmicus, acute anterior uveitis, scleritis, acute angle closure, chlamydial conjunctivitis, dry eye, foreign body.
• Complications: subepithelial corneal infiltrates with blurred vision, pseudomembranes and conjunctival scarring, secondary bacterial infection, dry eye, symblepharon.

Clinical diagnosis.

• Slit lamp examination with fluorescein for keratitis and pseudomembranes.
• Adenovirus rapid antigen test or PCR for outbreaks or doubt.
• Exclude herpetic disease: dendritic ulcer on fluorescein, vesicular rash on the forehead or nose.

Treatment is supportive; antibiotics do not help.

• Supportive: cold compresses, regular hand washing, do not share towels, avoid touching or rubbing the eyes, stay away from work or school for 5 to 7 days from onset, clean surfaces, discard eye make up, avoid contact lenses.
• Pharmacological: preservative free lubricants such as carboxymethylcellulose 0.5 percent every 2 to 4 hours; antihistamine drops such as olopatadine 0.1 percent twice daily for itch; paracetamol 1 g every 6 hours. Severe disease with pseudomembranes or subepithelial infiltrates: loteprednol 0.5 percent or fluorometholone 0.1 percent drops four times daily tapered over 2 to 4 weeks under ophthalmology care. Herpes simplex: aciclovir 3 percent ointment five times daily or ganciclovir 0.15 percent gel five times daily until the ulcer heals and for 3 days after; herpes zoster ophthalmicus: valaciclovir 1 g three times daily for 7 days.
• Procedures: peeling of pseudomembranes under topical anaesthesia by an ophthalmologist.
• Special groups: pregnancy, lubricants and cold compresses only; contact lens wearers, stop lenses until recovered; health workers, exclusion until resolution; infants, culture to exclude chlamydia and gonococcus.
• Red flags: reduced vision, severe pain, photophobia, corneal opacity, vesicular rash on the face, immunosuppression, no improvement after 2 weeks.
• Follow-up: review at 1 week if not improving; at 2 to 3 weeks for blurred vision.