Understand and manage viral conjunctivitis for clear and healthy eyes. Meri Sehat provides expert tips for eye health.

Viral Conjunctivitis

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Viral conjunctivitis is an inflammation of the conjunctiva, the semi-transparent membrane that lines the inside of the eyelid and covers the white part of the eye. 
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Viral conjunctivitis is the most common type of <a href="https://merisehat.pk/disease/an-eye-for-an-eye-conjunctivitis-has-taken-the-country-by-storm">conjunctivitis</a>. It is highly contagious and usually spreads in crowded areas or other vulnerable populations, such as schools. The viral infection epidemic keratoconjunctivitis is mostly associated with the term &ldquo;pink eye.&rdquo;

Nearly 90% of localized viral conjunctivitis without systemic manifestations is due to adenoviruses, while 1.3-4.8% is due to the herpes simplex virus or enteroviruses. 
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Further, cases of acute hemorrhagic conjunctivitis, a rare type of conjunctivitis associated with enterovirus type 70, have been observed in Asia and Africa.<a href="#accordion">[6]</a> Some studies have also reported that 1-6% of patients present with COVID-19 related conjunctivitis.

Viral conjunctivitis can occur equally in men and women and affect all age groups.<a href="#accordion">[9]</a> According to data, 1% of visits to primary care physicians in the US are related to conjunctivitis, with viral conjunctivitis being more common than the bacterial type.<a href="#accordion">[7]</a> 
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Sign and Symptoms

Viral conjunctivitis usually begins in one eye and then spreads to the other. When one eye is affected, it is referred to as unilateral conjunctivitis.

The main symptoms include:

<ul>
	<li>Watery discharge and redness in one or both eyes</li>
	<li>Morning crusting</li>
	<li>Stye or blepharitis</li>
	<li>Burning or gritty feeling</li>
	<li>Swollen eyelids</li>
</ul>

In particular, a case of viral conjunctivitis may present as pharyngoconjunctival fever (common and mild) or epidemic keratoconjunctivitis (less common and severe). It may include symptoms of a respiratory infection, such as a sore throat, fever, headache, and swollen lymph nodes. 
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Causes

Viral conjunctivitis may be due to a localized or systemic infection. Typically, it is caused by adenovirus. Sometimes, it can be due to local infection by herpes simplex virus, herpes varicella-zoster virus, picornaviruses (enterovirus 70 and coxsackievirus A24), poxvirus, and human immunodeficiency virus.<a href="#accordion">[3]</a>

These viruses are transmitted through direct contact with infected secretions (e.g., infectious tears, fecal matter, or respiratory discharges) or contaminated surfaces, leading to the spread of the infection. 
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There are no screening methods for viral conjunctivitis. 
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Diagnosis

Diagnosis is primarily based on the clinical presentation and history of exposure to infected individuals. However, in cases of suspected viral conjunctivitis, healthcare providers may perform laboratory tests, such as polymerase chain reaction (PCR) and viral DNA restriction analysis, to identify the specific viral pathogen causing the infection.<a href="#accordion">[2]</a>

It is important to differentiate viral conjunctivitis from bacterial and allergic conjunctivitis to guide appropriate treatment. 
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Treatment

Most cases of acute viral conjunctivitis are self-limited and do not require antimicrobial treatment. Symptoms usually worsen for a week and then gradually resolve in 14 days.

Generally, various over-the-counter treatments or home remedies help relieve the discomfort. These include applying cold or warm compresses several times a day, using lubricant eye drops or artificial tears, applying decongestant or antihistamine eye drops, and gently cleaning eye discharge from the eye with a clean cloth or sterile pad. 
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Sometimes, doctors may recommend oral or topical antiviral medication. This is usually for cases that are:

<ul>
	<li>Chronic</li>
	<li>Occur in newborns</li>
	<li>Severe, such as those caused by varicella-zoster virus</li>
	<li>Occur in people with weak immune systems</li>
</ul>

Other serious types of viral conjunctivitis, like epidemic keratoconjunctivitis, may require steroid eye drops.

Note: Antibiotics do not cure a viral infection. 
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A small number of severe cases cause serious complications, including keratitis, scarring of the eye, and damage to vision.<a href="#accordion">[5]</a> 
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The following factors increase the risk of contracting viral conjunctivitis:

<ul>
	<li>Individuals traveling to and from high-risk regions</li>
	<li>Babies&rsquo; exposure to STI during delivery</li>
	<li>Adults are more susceptible to viral conjunctivitis<a href="#accordion">[4]</a></li>
	<li>Certain occupations, such as healthcare workers examining patients with conjunctivitis</li>
	<li>More prevalent in summer<a href="#accordion">[8]</a> 
	&nbsp;</li>
</ul>

Practicing good hygiene can help prevent the spread of the infection.

<ul>
	<li>Wash hands often.</li>
	<li>Avoid touching or rubbing the eyes, especially after coming into contact with potentially contaminated surfaces or individuals.</li>
	<li>Ensure proper care of contact lenses.</li>
	<li>Avoid sharing clothing, cosmetics, and towels. Also, change your own bed linens, pillowcases, towels, etc. frequently to avoid reinfecting yourself.</li>
	<li>Clean and disinfect surfaces and objects that may come into contact with infected individuals.</li>
	<li>Avoid swimming in public swimming pools. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li style="list-style-type: none;">Viral conjunctivitis is an inflammation of the conjunctiva caused by viral infections, with adenoviruses being the most common causative agents.</li>
	<li>The condition presents with characteristic signs and symptoms such as watery discharge, hyperemia, and lymphadenopathy.</li>
	<li>Diagnosis is based on clinical examination and may involve laboratory tests such as PCR to identify the specific viral pathogen.</li>
	<li>Treatment includes supportive care, antiviral medications in severe cases, and home care measures to prevent the spread of the infection.</li>
	<li>Complications of viral conjunctivitis include keratoconjunctivitis and ligneous conjunctivitis, while risk factors include close contact, poor hygiene, and seasonal variation.</li>
	<li>Preventive measures focus on hand hygiene, avoiding eye rubbing, proper contact lens care, avoiding close contact, and environmental hygiene.</li>
</ul>

[1] Adenoviral keratoconjunctivitis - survey of Ophthalmology. Accessed December 21, 2023.

[2] Johari-Moghadam, M., Yari, M., Jalilian, F., Amini, R., & Bazzazi, N. (2019). &lt;p&gt;epidemiology and molecular diagnosis of acute conjunctivitis in patients attending hamadan, west iran ophthalmology clinics 2016–2017&lt;/p&gt;. Clinical Optometry, Volume 11, 105-111.

[3] Viral conjunctivitis. DermNet. Accessed December 21, 2023.

[4] Pink eye (conjunctivitis): Causes, treatment &amp; prevention. Cleveland Clinic. Accessed December 22, 2023

[5] Viral conjunctivitis: Symptoms, causes and treatment. Ada. Accessed December 22, 2023.

[6] Syed ZA. Viral conjunctivitis - eye disorders. MSD Manual Professional Edition. December 8, 2023. Accessed December 22, 2023.

[7] Solano D, Fu L, Czyz CN. Viral Conjunctivitis. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.