Viral Conjunctivitis

what are the types of viral conjunctivitis

1. non specific acute follicular conj

2. PCF - pharyngoconjunctival fever

3. EKC- epidemic keratoconjunctivitis

4. acute hemorrhagic conj

5. molluscum contagiosum

6. herpes involved keratoconj

viral conjunctivitis clinical signs

1. follicular reaction

   1. can also see in chlamydia and toxic conj

whats the most common cause of viral conj

adenovirus

• acute non specific

• epidemic keratoconj

• pharyngoconj fever

how does viral conj start

unilateral and becomes bilateral

• common cold in the eye

adenovirus

1. non enveloped doible stranded DNA

2. contagious

   1. usually spread thru respiratory or ocular secretions from contact

      1. hands to eyes

      2. instrument to eyes

what questions do we ask a pt in regards to viral conj

1. have you been sick recently

2. have you been around anyone who has been sick recently

3. any fever or fatigue

what will the pt say ab viral conj

1. I woke up w a red, crusty, and weepy eye

2. I went to urgent care adn they gave me an antibiotic drop but its not getting better

whats the most common viral conj

acute non specific conj

whats

acute non specific conj

caused by

several forms of adenovirus

signs and symptoms of acute non specific conj

1. follicular rxn

2. hyperemia

3. lacrimation

4. mild chemosis — swelling of conj

5. no corneal involvement

what causes pharyngoconj fever

AD 3 -7

what is pharyngoconj fever characterized by

1. pharyngitis

2. follicular conj

3. fever

4. prearicular adenopathy

   1. lateral canthus drains here

how is pharyngoconj fever different than EKC

NO sub epithelial infiltlrates in PCF

what this

pre auricular lymphadenopathy

• happens more in viral than it does in bacterial

how do we treat non specific and PCF viral conj

1. takes 2-3 weeks to resolve

2. CONTAGIOUS for 10-12 days

   1. be clean, no contacts, clean sheets

3. use artificial tears that are refridgerated

4. self limiting

how do we f/u for non specific and PCF viral conj

5-7 days

what causes EKC

AD 8

what are signs and symptoms of EKC

1. matted lashes

2. diffuse hyperemia/ conj hemes

3. follicular rxn

4. lid edema

5. pseudo membranes

6. tearing

7. sub epithelial infiltrates

whats the rule of 8

EKC

1. ADenovirus 8

2. red eye w staining for 8 days

3. 8 days of immune response - sub epithelial infiltrates (WBC in cornea)

4. 8 days of resolution

whats this and whats it associated w

sub epithelial infiltrates

EKC

collection of immune cells wi the cornea

occurs 2-3 weeks after initial presentation - think rule of 8

how do we treat the membranes and pseudomembranes

1. can gently peel w cotton tip applicator/ jewlers forceps

how do we treat sub epithelial infiltrates

1. long term taper of weaker steroids

   1. loteprednol 0.5% TID w elongated taper

      1. monitor IOP (its as soft steroid but still)

acute hemorrhagic conj cause

enteroirus 70 or adenovirus 11

RARE

acute hemorrhagic conj signs and symptoms

1. significant conj hyperemia and hemorrhages

2. sig chemosis

3. lid edema

4. FB sensation

how do you treat acute hemorrhagic conh

• its contagious so limit human contact

• clean

• self limiting in 7 days - artificial tears and cool compresses

compare bacterial and viral

1. bacterial

   1. papillae

   2. mucopurulent discharge

2. viral

   1. follicles

   2. watery discharge

is it more liekly to be bacterial or viral conj in adults

viral

herpes simplex/zoster virus

1. contagious virus wi the herpesvirus family that can spread thru direct contact

   1. HSV - 1 orofacial COLD SORES

   2. HSV - 2 below the waist and sexual

2. both can establish latency in sensory neurons and when activated caus elesions onthe body

what do you have to ask ab when you see follicles

HSV/ HZO

• cold sores

what does herpes simplex keratoconh present as

1. unilateral follicular conj

2. dendrites

whats this

herpes simplex

• peri orbital lesions

what does viral conj follow the distribution of

trigeminal nerve

how do we treat HSV keratoconj

1. valacyclovir - 500 mg TID PO 7-14 days

2. acyclovir - 400 mg 5x per day PO 7-14 days

3. famciclovir - 250 mg TID PO 7-14 days

4. Zirgan - 5x per day

5. Viroptic - 8 x per day = bad bc after 21 days it cuases corneal melt

how do the drug amounts differ for HZO and HSV

1. HSV is half

2. so for HZO it would be Valacyclovir 1 g TID PO 7-14 days

whats a side effect of viroptic

corneal melt

molluscum contagiosum signs and symptoms

1. follicular conj

2. lid margin lesions

   1. umbilicated, waxy, flesh colored

epi of molluscum contagiosum

kids