Viral Conjunctivitis

What is Viral Conjunctivitis?

Conjunctivitis is an inflammation of the conjunctiva, the outer transparent mucous membrane covering the sclera and the inner surface of the eyelids.

Viral conjunctivitis, most often associated with an infection of the upper respiratory tract (adenoviral or herpetic), can occur with a common cold and / or sore throat.

Viral conjunctivitis is now becoming very common. They are very contagious and the disease in many cases becomes an epidemic. Conjunctivitis causes a large number of viruses of different types.

Causes of Viral Conjunctivitis

According to modern data, more than 150 viruses have been recognized as pathogenic for humans, and most of them in one form or another can also affect the organ of vision. Some eye diseases of this origin (for example, epidemic viral keratoconjunctivitis and pharyngoconjunctival fever) were described at the beginning of the last century (Fuchs E, 1889). However, their adenoviral nature was established much later – in the early 60s of the XX century. (Paroff W. E. et al., 1954; Jawetz E. et al., 1955, etc.). Some viral eye lesions have become known recently. So, in 1969-1970. in Africa, a pandemic of previously unknown epidemic hemorrhagic conjunctivitis occurred, the causative agent of which was enterovirus-70, which is part of the group of picornaviruses (Kono R. et al., 1972, etc.).

Herpesviruses also play a significant role in the pathology of the eyes. However, they affect its tissues in an endogenous way, and therefore are practically not dangerous in epidemiological terms, which differ significantly from adeno-and picornaviruses. Active study of adenoviruses began in 1952.

To date, over 45 different types of pathogens of this group have been immunologically identified, of which 28 have been isolated from humans. It has been established that serotypes A-3 and A-7 cause the development of faringo-conjunctival fever or, as they are now often called, adenoviral conjunctivitis (AVK), and A-8 – epidemic keratoconjunctivitis (EKC). All adenoviruses have sizes from 60 to 86 nm, multiply in the nuclei of epithelial cells and have a common antigen. Their core consists of double-stranded DNA. Survives well in medicinal solutions, in particular in eye drops. Inactivated with 0.5 and 1% solutions of chloramine and 5% phenol solution. The group of picornaviruses includes small (25-30 nm) and simply arranged RNA viruses, including enterovirus-70, which is the causative agent of epidemic hemorrhagic conjunctivitis (EGC).

Symptoms of Viral Conjunctivitis

Signs (symptoms) of viral conjunctivitis:

  • Abundant tearing;
  • Irritation of the eye;
  • The eye is red;
  • The defeat at the beginning of one eye with a frequent continuation of the other.

Herpetic conjunctivitis.
This type of inflammation of the mucous membrane of the eye causes the herpes simplex virus. Most often, children are ill. Usually, the herpes virus affects one eye. The course of the disease is obliterated, sluggish. The disease is prolonged. Almost always the process is accompanied by a rash of herpetic vesicles on the skin of the eyelids.

Herpetic conjunctivitis can be:

  • catarrhal
  • follicular or vesicular-ulcerative.

The catarrhal form of herpetic conjunctivitis is characterized by ease of flow. Manifestations of the disease are mild. The mucous discharge from the eyes, its amount is small. Occasionally, the adherence of the bacterial flora occurs and the discharge from the eye becomes purulent. Redness of the conjunctiva of the eye is mild.

When the follicular form on the conjunctiva follicles (bubbles) are formed. The vesicular-ulcerative form of herpetic conjunctivitis is the most severe. At the same time on the conjunctiva of the eyelids and the edges of the eyelids are formed erosion or ulcers. Sores are covered with a thin film. There are complaints of tearing, the inability to look at the light.

Adenoviral conjunctivitis.
Adenoviral conjunctivitis is also called pharyngoconjunctival fever. Only recently the viral nature of this disease has been clarified. In adenoviral conjunctivitis, in addition to eye damage, there is pharyngitis, an increase in body temperature, which occurs at the beginning of the disease. Conjunctivitis joins later, first on one, then on the second eye. Eyelids swell. Mucous eyes red. A scanty transparent mucous discharge appears.

There are three forms of this disease:

  • In the catarrhal form of adenoviral conjunctivitis, inflammation is only slightly pronounced. Redness is small, the amount of discharge, too. For easy. Duration of illness up to one week.
  • In 25% of cases, the membranous form of adenoviral conjunctivitis occurs. In this form, thin films of grayish-white color are formed on the mucous membrane of the eye, which can be easily removed with a cotton swab. Sometimes films can be tightly soldered to the conjunctiva, and a bleeding surface is exposed beneath them. In this case, it is necessary to conduct an examination for diphtheria. After the disappearance of the films, there are usually no traces left, but sometimes rough scars may appear. In the conjunctiva, point hemorrhages and infiltrates (seals) may also occur, which after rescue completely dissolve.
  • When the follicular form of adenoviral conjunctivitis on the mucous membrane of the eye small bubbles appear, sometimes they are large.

Epidemic keratoconjunctivitis.
This type of keratoconjunctivitis is extremely contagious. It affects the adult population. Sick whole families, groups. Cause of epidemic keratoconjunctivitis is a type of adenovirus. Infection is transmitted by contact through dirty hands, household items, underwear. Infection with medical ophthalmological instruments is possible through the hands of medical personnel.

From the moment of infection to the onset of the disease takes about a week. Initially, the disease may appear headache, mild weakness, sleep disturbance. Initially, one eye gets sick, but the second soon joins. Complaints appear on the sensation of eye contamination, lacrimation, discharge from the eyes. Eyelids look swollen, mucous membrane reddened. In the conjunctival sac is a moderate amount of mucopurulent discharge. Sometimes thin films form on the conjunctiva and are easily removed with a cotton swab.

The lymph nodes in the submandibular region and near the ear can grow and become painful. After a week, the condition improves and all manifestations seem to disappear. A few days after improvement, tearing and the feeling of weediness of the eyes increases, photophobia appears. Sometimes there is a feeling of deterioration in vision. This joins the inflammatory process in the cornea of ​​the eye, on which multiple point opacities occur.

The disease can last up to two months. When the cornea becomes cloudy, it is usually completely absorbed and the vision is restored. After suffering an epidemic keratoconjunctivitis, immunity remains for life.

Complications of viral conjunctivitis
One of the complications of conjunctivitis, leading to serious consequences with possible loss of vision, is keratitis. That is why it is so important to start treating conjunctivitis in time.

Diagnosis of Viral Conjunctivitis

Conjunctivitis is determined by routine inspection on a slit lamp. In some cases, a smear / scraping of the conjunctiva may be necessary to determine the appearance of the microorganism and the type of cellular response of the microorganism, as well as taking the material for seeding into culture media for growing bacteria and more accurate identification.

Diagnosis of adeno-and picornaviral eye diseases is based mainly on the features of their clinical picture and the results of laboratory studies. Among the latter, cytological, immunofluorescent (MFA) and enzyme immunoassay (ELISA) are of particular importance. The cytological method is based on identifying characteristic changes in epithelial cells stained according to Romanovsky-Giemsa. In the adenoviral process, they detect degeneration of epithelial cells with vacuolization of nuclei and chromatin disintegration, the presence of monocytes with intraplasmic inclusions and neutrophils in the exudate.

Treatment of Viral Conjunctivitis

Viral conjunctivitis requires the appointment of antiviral drops, interferon and antiviral ointments. Of particular importance is the restoration of the immune status of the patient, since the viral lesion of the conjunctiva is usually associated with a weakening of the body’s defenses. Multivitamins with microelements in combination with herbal stimulation of the immune system will only benefit and accelerate recovery.

To relieve the symptoms of viral conjunctivitis, warm compresses and artificial tears are used. To alleviate the severe signs of conjunctivitis, eye drops containing corticosteroid hormones may be prescribed. However, their prolonged use has a number of side effects.

A specific antiviral drug for the treatment of viral conjunctivitis are eye drops Ophthalmoferon containing recombinant interferon type alpha 2. When attaching a secondary bacterial infection, drops are prescribed that contain antibiotics. In conjunctivitis caused by the herpes virus (herpes conjunctivitis), agents containing acyclovir and ophthalmoferon are prescribed.

When conjunctivitis should not touch the eyes with his hands, it is important for patients to observe the rules of personal hygiene, wash hands thoroughly and use only your own towel so as not to infect other family members. Viral conjunctivitis usually disappears within 3 weeks. However, the treatment process may take more than a month.

The course of treatment of viral conjunctivitis usually lasts one to two weeks. Since this disease is not caused by bacteria, viral conjunctivitis does not respond to antibiotics. Artificial tears will also help relieve the unpleasant symptoms of conjunctivitis.

Conjunctivitis caused by the herpes virus can be treated with antiviral eye drops, ointment and / or antiviral drugs.

Prevention of Viral Conjunctivitis

How can I prevent the development of conjunctivitis?

If you or your child have conjunctivitis:

  • Do not touch or rub the infected eye.
  • Wash your hands more often with soap and warm water.
  • Wash away any particles that hit your eyes twice a day, each time using a new cotton swab or paper towel. Afterwards, wash your hands with soap and warm water.
  • Wash your bedding, pillowcases and towels in hot water and detergent.
  • Do not apply eye makeup.
  • Do not share your eye makeup with anyone.
  • Never wear another person’s contact lenses.
  • Wear glasses instead of contact lenses. Throw away used lenses and make sure that for all occasions it is better to use safety glasses.
  • Do not share things such as unwashed towels or glasses.
  • Wash your hands after applying eye drops or ointment to your eyes or the eyes of your child.
  • Do not use eye drops that you have buried in an infected eye, and then use it on an uninfected eye.
  • If your child has bacterial or viral conjunctivitis, keep your child at home until he or she is considered infectious anymore.


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