Viral conjunctivitis

What it is

Viral conjunctivitis is mainly due to adenovirus, which is the most common agent causing it, and it is highly contagious for up to 12 d. In the red eye table the buzzwords beside it are adenovirus and swimming pool.

Causes and risk

Sick contacts are very important to ask about, and a positive family history of the same problem is part of the history. The eye may not come alone: a rhinorrhea may run with the red eye, and the table puts URI beside the viral form.

How it presents

There is a serous, watery discharge with lid edema and follicles, and subepithelial corneal infiltrates. The congestion is bilateral and generalized, with conjunctival follicles. It is initially unilateral and often progresses to the other eye, so the involvement of the eyes is sequential.

A preauricular node is often palpable and tender, and this lymphadenopathy is on the same side; note that the examination in one worked vignette instead gives a nontender preauricular lymph node, so do not drop the diagnosis because the node does not hurt. Preauricular adenopathy is what is associated with a viral etiology.

VA is not affected, unless rarely the cornea gets affected. In the acute red eye table the row reads: pain mild, no photophobia, no drop in vision, watery discharge, normal pupil, no ciliary flush.

The worked case is a 35-year-old woman with a right-sided red eye for 3 days, no pain, watery discharge, coughing and congested for the past 5 days, temperature 98.4 F, visual acuity 20/20, erythematous conjunctiva with minimal chemosis and clear discharge, an unremarkable slit-lamp, fluorescein and funduscopic examination, a nontender preauricular lymph node and enlarged tonsils without exudates.