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06-04-2012, 02:58 PM

Typical signs of adenoviral conjunctivitis include:

preauricular adenopathy, epiphora, hyperemia, chemosis, subconjunctival hemorrhage, follicular conjunctival reaction, and occasionally a pseudomembranous or cicatricial conjunctival reaction.

The cornea often demonstrates a punctate epitheliopathy.

The eyelids often are edematous and ecchymotic. In severe cases, there can be a corneal epithelial defect. It typically begins in one eye and progresses to the fellow eye over a few days.

With HSV infection, vesicles may be present on the eyelid or face, the eyelids may be swollen, and an ulcerative blepharitis may be present.

Corneal involvement in HSV manifests as a dendritic keratitis with typical features of linear branching and dendritic figures.

Small, papular lesions that erupt along the lid margin or at the limbus are present with varicella conjunctivitis. These lesions may resolve without sequelae, or they may become pustular and form painful, reactive conjunctival ulcers.

In herpes zoster ophthalmicus, look for skin involvement with the appearance of a dermatomal pattern of vesicles. These vesicles may become necrotic, resulting in pitted scarring of the skin. Conjunctival involvement includes hyperemia, follicular or papillary conjunctivitis, and a serous or mucopurulent discharge. Preauricular adenopathy is common. Very early in the process, there may be multiple fine, dendritic corneal lesions, which disappear over a few days without treatment.

Acute hemorrhagic conjunctivitis starts unilaterally but rapidly involves the fellow eye within 1 or 2 days. Signs on examination include a swollen, edematous eyelid and pronounced hemorrhage beneath the bulbar conjunctiva.


Symptomatic Treatment
Patients should be instructed to use cold compresses and lubricants, such as artificial tears, for comfort.

Topical vasoconstrictors and antihistamines may be used for severe itching but generally are not indicated, because they are minimally helpful and may cause rebounding of symptoms, as well as local toxicity and hypersensitivity.

Antibiotic and Topical Steroid Treatment
For patients who may be susceptible, a topical astringent or antibiotic may be used to prevent bacterial superinfection.

Topical steroids may be used for pseudomembranes or when subepithelial infiltrates impair vision, although subepithelial infiltrates may recur after discontinuing the steroids. Extreme caution should be taken when using corticosteroids, as they may worsen an underlying HSV infection.

A study by Wilkins et al focused on whether topical steroids improve the comfort of patients compared with hypromellose in acute presumed viral conjunctivitis. It found that the use of a short course of topical dexamethasone for patients with acute follicular conjunctivitis presumed to be viral in origin was not harmful






EKC adenovirus causing viral conjunctivitis