Viral Conjunctivitis

1. See Also
   1. Epidemic Keratoconjunctivitis
   2. Herpes Simplex Conjunctivitis
2. Epidemiology
   1. Common cause of Swimming Pool Conjunctivitis
   2. Chlorine does not eliminate the virus
3. Causes
   1. Adenovirus (most common)
   2. Enterovirus
   3. Coxsackievirus
   4. Varicella Zoster Virus
   5. Epstein-Barr Virus
   6. Herpes Simplex Virus (Herpes Keratitis)
   7. Influenza
4. Symptoms
   1. Associated Upper Respiratory Infection
   2. Severe Pharyngitis
   3. Watery Eye Discharge
   4. Insidious onset over 36 hours
   5. Mild to no pain (eye may feel gritty)
   6. Mild eye itch
   7. Diffuse Conjunctival Hyperemia
   8. Unilateral initially and spreads to opposite eye within 1-2 days
5. Signs
   1. Marked Conjunctival erythema
   2. Epiphora (Eye tearing)
   3. Preauricular Lymphadenopathy (anterior to tragus)
      1. Highly suggestive of Viral Conjunctivitis
   4. Mild palpebral Conjunctival follicular response
   5. Multiple small subepithelial Corneal infiltrates (severe cases)
   6. Fever
6. Differential Diagnosis
   1. Epidemic Keratoconjunctivitis
   2. Bacterial Conjunctivitis
7. Management
   1. Conditions requiring urgent ophthalmology referral
      1. Herpetic Conjunctivitis
   2. Warm soaks to keep lids and lashes free of debris
   3. Practice good hygiene to prevent contagious spread
   4. Topical lubricant (Methylcellulose)
   5. Antibiotic not indicated in Viral Conjunctivitis
      1. See Bacterial Conjunctivitis
8. Prevention
   1. Frequent hand washing
   2. Do not share towels
   3. Wipe contaminated surfaces with bleach
      1. Adenovirus survives on surfaces for 72 hours
9. Course
   1. Eye discomfort may persist for up to 10 days
   2. Infectious while excessive eye watering continues
10. Resources (Include Patient Education)
    1. See Conjunctivitis Resources