Viral Conjunctivitis

Aka: Viral Conjunctivitis, Pink Eye, Adenopharyngitis Associated Conjunctivitis

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II. Epidemiology

  1. Viral Conjunctivitis is most common Conjunctivitis cause (80% of cases)
    1. Viral Conjunctivitis accounts for 55 to 80% of Conjunctivitis cases in adults
    2. Bacterial Conjunctivitis is more common in children (up to 71% of cases)
  2. Typically spread by contaminated hands
  3. Viral sources can survive on fomites for up to 72 hours
  4. Common cause of Swimming Pool Conjunctivitis (esp. Adenovirus)
    1. Chlorine does not eliminate Adenovirus

III. Causes

  1. Adenovirus (most common)
    1. Highly contagious (survives up to 28 days, 30% transmission rate)
    2. Transmitted via fomites (e.g. fingers, cosmetics) and swimming pools
  2. Epidemic Keratoconjunctivitis (more severe, Lymphadenopathy)
  3. Enterovirus
  4. Coxsackievirus
  5. Varicella Zoster Virus (Herpes Ophthalmicus)
  6. Epstein-Barr Virus (EBV, Mononucleosis)
  7. Herpes Simplex Virus (Herpes Keratitis)
  8. Influenza

IV. Symptoms

  1. Mild watery Eye Discharge or tearing
  2. Insidious onset over 36 hours
  3. Mild eye burning to no pain (eye may feel gritty)
  4. Mild eye itch
  5. Diffuse Conjunctival Hyperemia
  6. Unilateral initially and spreads to opposite eye within 1-2 days
  7. Associated symptoms
    1. Upper Respiratory Infection
    2. Severe Pharyngitis with some infections (e.g. coxsackievirus, Mononucleosis)

V. Signs

  1. Marked Conjunctival erythema
  2. Epiphora (Eye tearing)
  3. Preauricular Lymphadenopathy (anterior to tragus)
    1. Highly suggestive of Viral Conjunctivitis (especially Adenovirus)
  4. Mild palpebral Conjunctival follicular response
  5. Multiple small subepithelial Corneal infiltrates (severe cases)
  6. Fever

VI. Differential Diagnosis

  1. Epidemic Keratoconjunctivitis
  2. Bacterial Conjunctivitis

VII. Precautions: Red Flags

  1. See Conjunctivitis
  2. See Herpes Ophthalmicus

VIII. Management

  1. Conditions requiring urgent ophthalmology referral
    1. Herpetic Conjunctivitis
    2. Epidemic Keratoconjunctivitis
  2. Warm soaks to keep lids and lashes free of debris
  3. Cool compresses may be soothing
  4. Practice good hygiene to prevent contagious spread
    1. Hosts shed Adenovirus for 10 to 14 days
    2. Avoid exposing others for at least 7 days, and at least until Red Eye and tearing resolves
  5. Topical lubricant eye drops (Methylcellulose, Refresh Tears) or artificial tears
  6. Remove Contact Lens and do not wear again until Conjunctivitis resolves
  7. Avoid Topical Corticosteroids (prolonged viral shedding, Glaucoma risk)
  8. Antibiotic not indicated in Viral Conjunctivitis
    1. See Bacterial Conjunctivitis
    2. Risk of Antibiotic Resistance, transmission of Viral Conjunctivitis to contralateral eye, chemical Conjunctivitis

IX. Prevention

  1. Frequent Hand Washing
  2. Do not share towels, pillowcases or eye makeup
  3. Throw away used Contact Lenses and their case
  4. Throw away used eye makeup
  5. Avoid touching your face
  6. Wipe contaminated surfaces with bleach
    1. Adenovirus survives on surfaces for 72 hours

X. Course

  1. Eye discomfort may persist for up to 10 days
  2. Infectious while excessive eye watering continues (typically 10-14 days)
    1. Return if failed resolution by 2 to 3 weeks

XI. Resources (Include Patient Education)

  1. See Conjunctivitis Resources

XII. References

  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]
  3. Winters (2024) Am Fam Physician 110(2):134-44 [PubMed]

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Related Studies

Ontology: Viral Conjunctivitis (C0009774)

Definition (MSHCZE) Zánět spojivek (konjunktivitida) způsobený viry, často adenoviry, někdy s epidemických charakterem (k. epidemická). Může být komplikován postižením rohovky (keratokonjunktivitida, keratitis nummularis) s určitým stupněm poruchy visu. Mohou být i lehčí celkové příznaky, zduření preaurikulárních uzlin. Léčebně se podávají antiseptika, ev. antibiotika s kortikoidy. Dostupná virostatika neúčinkují na adenoviry. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Inflammation, often mild, of the conjunctiva caused by a variety of viral agents. Conjunctival involvement may be part of a systemic infection.
Concepts Disease or Syndrome (T047)
MSH D003236
ICD10 B30 , B30.9
SnomedCT 186680005, 187462004, 186682002, 367106004, 45261009
English Conjunctivitides, Viral, Conjunctivitis, Viral, Viral Conjunctivitides, Viral conjunctivitis, unspecified, Viral conjunctivitis,unspcf, [X]Viral conjunctivitis, unspecified, [X]Viral conjunctivitis,unspcf, Conjunctivitis viral NOS, Conjunctivitis, Viral [Disease/Finding], Conjunctivitis;viral, viral conjunctivitis, conjunctivitis viral, [X]Viral conjunctivitis, unspecified (disorder), Viral ccnjunctivitis, Conjunctivitis viral, Viral conjunctivitis, Viral conjunctivitis (disorder), conjunctiva; disorder, viral (etiology), conjunctiva; disorder, viral (manifestation), conjunctivitis; viral (etiology), conjunctivitis; viral (manifestation), disease (or disorder); conjunctiva, viral (etiology), disease (or disorder); conjunctiva, viral (manifestation), infection; viral, conjunctivitis, viral; infection, conjunctivitis, virus; conjunctivitis (etiology), virus; conjunctivitis (manifestation), Viral conjunctivitis, NOS, Viral Conjunctivitis, Viral conjunctivitis NOS
Dutch conjunctivitis viraal NAO, virale conjunctivitis, aandoening; conjunctiva, virus, conjunctiva; aandoening, virus, conjunctivitis; virus, infectie; viraal, conjunctivitis, viraal; infectie, conjunctivitis, virus; conjunctivitis, Virale conjunctivitis, niet gespecificeerd, conjunctivitis viraal, Conjunctivitis, virale, Virale conjunctivitis, Virusconjunctivitis
French Conjonctivite virale SAI, Conjonctivite virale
German Konjunktivitis viral NNB, Konjunktivitis durch Viren, nicht naeher bezeichnet, virale Konjunktivitis, Konjunktivitis, Virus-, Viruskonjunktivitis, Bindehautentzündung, Virus-
Italian Congiuntivite virale NAS, Congiuntivite virale
Portuguese Conjuntivite vírica, Conjuntivite viral NE, Conjuntivite viral, Conjuntivite Viral
Spanish Conjuntivitis vírica, Conjuntivitis vírica NEOM, conjuntivitis vírica, conjuntivitis virósica, [X]conjuntivitis viral, no especificada (trastorno), [X]conjuntivitis viral, no especificada, conjuntivitis viral (trastorno), conjuntivitis viral, Conjuntivitis viral, Conjuntivitis Viral
Japanese ウイルス性結膜炎ＮＯＳ, ｳｲﾙｽｾｲｹﾂﾏｸｴﾝ, ｳｲﾙｽｾｲｹﾂﾏｸｴﾝNOS, ウイルス結膜炎, 結膜炎-ウイルス性, ウイルス性結膜炎
Swedish Bindhinneinflammation, viral
Czech konjunktivitida virová, Virová konjunktivitida NOS, Virová konjunktivitida
Finnish Viruksen aiheuttama sidekalvotulehdus
Russian VIRUSNYI KON"IUNKTIVIT, KON"IUNKTIVIT VIRUSNYI, ВИРУСНЫЙ КОНЪЮНКТИВИТ, КОНЪЮНКТИВИТ ВИРУСНЫЙ
Korean 바이러스 결막염, 상세불명의 바이러스 결막염
Polish Zapalenie spojówek wirusowe
Hungarian Viralis conjunctivitis, virusos conjunctivitis, virusos conjunctivitis k.m.n.
Norwegian Viral konjunktivitt, Konjunktivitt, viral
Derived from the NIH UMLS (Unified Medical Language System)

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