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Viral Conjunctivitis

Viral conjunctivitis

What is it?
Viral conjunctivitis is the most common cause of an acute red eye. A self-limited infection, it usually resolves within a week and leaves no permanent damage. It probably spreads by contact; contagiousness varies with the viral species.

Caused most often by adenovirus, it cannot be treated effectively with antimicrobial agents. Instead, management is directed at scrupulous hygiene to prevent spread, which is most likely when discharge is present.

How does it present?
The patient reports a swollen, tight, warm, uncomfortable feeling in the affected eye and a watery/mucoid discharge. Vision is usually normal unless mucus gets on the cornea, which can be blinked away. One or both eyes may be involved. There may be an ongoing or preceding upper respiratory infection or a history of recent exposure to someone with a red eye.

The conjunctiva is diffusely hyperemic. The eyelids are slightly swollen. The eye is dripping with a watery and mucoid—but not purulent—discharge. A tender pre-auricular node is often present.

What to do?
Don't prescribe anti-infectives! They don't work, and applying them only leads to infection of an unaffected eye or other people's eyes.

Instead, urge two principles:

  • Hygiene: wash hands frequently, avoid touching the eyes and sharing towels.
  • Quarantine: stay away from communal activities—work, school, daycare—as long as discharge is present.
Refer only if:

  • The diagnosis is in question.
  • Symptoms appear to worsen.
  • Keratitis is suspected.
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