Public - Acute Viral Conjunctivitis

Acute Viral Conjunctivitis

Author: Stephen Orlin, MD
Module updated - 2008-04-08
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
	Figures
	References
	Glossary
	What's New
	Patient Information
	Additional Resources
	Tools

Diagnosis
Take a careful history to confirm the diagnosis of viral conjunctivitis. Perform a basic eye examination. Use selected tests to assist in the differential diagnosis of unusual forms of conjunctivitis. Consider other causes of conjunctival inflammation.
History and Physical Examination Elements for Viral Conjunctivitis (table)
Laboratory and Other Studies for Conjunctivitis (table)
Differential Diagnosis of Acute Viral Conjunctivitis (table)


Take a careful history to confirm the diagnosis of viral conjunctivitis.
Ask about: Itching Onset and duration of symptoms in each affected eye Watery or mucoid discharge Sticking together of lids Ocular pain and discomfort Foreign body sensation Light sensitivity Blurred vision Similar eye infection in family members or other close contacts Upper respiratory symptoms Headache Muscle weakness Use of contact lenses History of rheumatologic disease See table History and Physical Examination Elements for Viral Conjunctivitis.
Background \| Back to top

Perform a basic eye examination.
Test Snellen visual acuity. Look for conjunctival hyperemia, chemosis, superior and inferior subconjunctival hemorrhages, follicles, lid swelling, and watery discharge. Palpate for preauricular lymphadenopathy. Inspect the bulbar and palpebral conjunctival surface. Consider performing a rapid in-office immunoassay to aid in differentiating viral from bacterial disease. Refer patient to an ophthalmologist for examination of the corneal surface with fluorescein dye and slit lamp if there is significant blurred vision, severe pain, and photophobia suggesting corneal involvement, or a history of concurrent contact lens use. See table History and Physical Examination Elements for Viral Conjunctivitis. See figure Acute Adenoviral Conjunctivitis. See figure Follicular Conjunctivitis. See figure Pseudomembranes. See figure Acute Hemorrhagic Conjunctivitis. See figure Corneal Infiltrates.
Background \| Back to top

Use selected tests to assist in the differential diagnosis of unusual forms of conjunctivitis.
Consider obtaining: Rapid, point-of-care immunoassays to detect adenovirus Cytology specimen of conjunctival epithelium, which may show intracytoplasmic inclusions in suspected chlamydial conjunctivitis PCR to screen for chlamydia, atypical HSV, or adenovirus Cytology specimen, which may show eosinophilia in suspected allergic conjunctivitis Culture of the conjunctiva in suspected chlamydia or herpes virus Bacterial culture if there is purulent discharge, particularly in patients with hyperacute purulent conjunctivitis, which may reveal N. gonorrhea Conjunctival biopsy specimen in patients with suspected sarcoid and ocular cicatricial pemphigoid See table Laboratory and Other Studies for Conjunctivitis.
Background \| Back to top

Consider other causes of conjunctival inflammation.
In the differential diagnosis of adenoviral conjunctivitis, consider: Bacterial conjunctivitis Other viral causes (herpes simplex, herpes zoster, enterovirus, coxsackievirus, molluscum contagiosum) Chlamydia trachomatis Allergic conjunctivitis Sexually transmitted conjunctivitis (e.g., chlamydia, herpes, gonorrhea, syphilis, and HIV) Other inflammatory causes of conjunctivitis (e.g., sarcoid, superior limbic keratoconjunctivitis, cat scratch disease) Episcleritis and scleritis Blepharitis Dry eyes See table Differential Diagnosis of Acute Viral Conjunctivitis.
Background \| Back to top

FAQs

Robert Sambursky, MD, editorial consultant, Chief Medical Officer for Rapid Pathogen Screening, Inc.;served as consultant for Rapid Pathogen Screening, Inc.;received an honoraria for Rapid Pathogen Screening, Inc.;serves as consultant for Rapid Pathogen Screening, Inc; owns stock options in Rapid Pathogen Screening, Inc.;served as board member or director for Rapid Pathogen Screening, Inc.;received grants and has grants pending from Rapid Pathogen Screening, Inc.;and has received patents and has patents pending for Rapid Pathogen Screening, Inc. Stephen Orlin, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Because all PIER modules are updated regularly, printed web pages or PDFs may rapidly become obsolete. Therefore, PIER users should compare the date of the last update on the website with any printout to ensure that the information being referred to is the most current available.

PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.