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viral conjuctivitis
Viral conjunctivitis is caused by various viruses that infect the conjunctiva. The most common types are adenoviral conjunctivitis, caused mainly by adenovirus types 8 and 19, and herpes simplex conjunctivitis caused by HSV-1. Adenoviral conjunctivitis presents with redness, watering, follicles and can cause punctate keratitis if the cornea is involved. Treatment focuses on supportive care and antibiotics to prevent secondary infections. Acute hemorrhagic conjunctivitis is caused by enterovirus 70 and presents with redness, watering, hemorrhages and follicles. Ophthalmia neonatorum can be caused by gon
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viral conjuctivitis
- 1. VIRAL CONJUCTIVITIS SITI MARIAMBINTI MOHD HAMZAH
- 2. Most of viralinfections tend to affect the epithelium both of the conjunctiva and cornea; thus the typical viral lesion is a ‘keratoconjunctivitis’
- 3. Viral infections ofconjunctiva • Adenovirus conjunctivitis • Herpes simplex keratoconjunctivitis • Herpes zoster conjunctivitis • Molluscum contagiosum conjunctivitis • Poxvirus conjunctivitis • Myxovirus conjunctivitis • Parammyxovirus conjunctivitis • ARBOR virus conjunctivitis Clinical Presentations of acute VC: Acute follicular conjunctivitis Acute haemorrhagic conjunctivitis
- 4. Adenoviral Conjunctivitis • Adenovirusesare the commonest causes of viral conjunctivitis • Non-enveloped, double stranded DNA viruses, which replicate within the nucleus of host cells. General reservoir is only human. Type of adenoviral conjunctivitis • Epidemic keratoconjunctivitis (EKC) • Nonspecific acute follicular conjunctivitis • Pharyngoconjunctival fever (PCF) • Chronic relapsing adenoviral conjunctivitis
- 5. 1. Epidemic Keratoconjunctivitis(KC) • A type of acute follicular conjunctivitis mostly associated with superficial punctate keratitis & usually occurs in epidemics, hence EKC. • Caused by adenoviruses type 8 & 19. (it is markedly contagious) • incubation period after infection (8 days) & virus shed from the inflamed eye for 2-3 weeks. Symptoms • Redness of sudden onset + watering, usually profuse, with mild mucoid discharge • Ocular discomfort & foreign body sensation. • (mild) photophobia, become marked when cornea is involved.
- 6. Signs • Conjunctiva: • Hyperaemiaprominent • Chemosis is present • Follicles (lower fornix & palpebral conjunctiva) • Papillary reaction • Petechial subconjunctival haemorrhages (severe adenoviral conjunctivitis) • Pseudomembrane lining (lower fornix & palpebral conjunctiva) • Cornea: • Epithelial microcystic diffuse fine non-staining lesions • Superficial punctate keratitis (SPK) • Pre-auricular lymphadenopathy.
- 7. Treatment I. Supportive treatmentfor amelioration of symptoms is the only treatment required and includes: • Cold compresses, and sun glasses to decrease glare, • Decongestant and lubricant tear drops to decrease discomfort II. Topical antibiotics; to prevent superadded bacterial infections Prevention of spread of infection to the contacts - Highly contagious and patients may be infectious for up to 11 days after onset Transmission usually occurs • From eyes to fingers to eyes • Tonometers, contact lenses and eye drops
- 8. 2. Nonspecific AcuteFollicular Conjunctivitis • Most common form of acute follicular conjunctivitis • Caused by adenovirus serotypes 1 to 11 & 19 • Milder form of acute follicular conjunctivitis. • Treatment similar as EKC
- 9. 3.Pharyngoconjunctival Fever (PCF) •adenoviral infection commonly associated with subtypes 3 & 7. • PCF primarily affect children & appears in epidemic form • Treatment is similar as EKC Clinical features • Acute follicular conjunctivitis, associated with pharyngitis. • Fever & pre-auricular lymphadenopathy. • Cornea : superficial punctate keratitis. (30%)
- 10. Acute Herpetic Conjunctivitis •Always an accompaniment of the ‘primary herpetic infection’, mainly occur in children and adolescents. • Commonly caused by herpes simplex virus type 1 and spreads by kissing or other close personal contacts. • HSV type 2 associated with genital infections, may also involve the eyes in adults as well as children, though rarely. • Treatment • Usually self limiting • Topical antiviral drugs control the infection effectively and prevent recurrences • Supportive measures are similar with EKC
- 11. • Clinical features •Usually unilateral affection • May occur in 2 forms: typical and atypical • Typical form: follicular conjunctivitis and other primary infection such as vesicular lesions of face & lids • Atypical form: follicular conjunctivitis without lesions of face, eyelid. The condition resembles epidemic keratoconjunctivitis but may envolve through phases of no-specific hyperaemia, follicular hyperplasia & pseudomembrane formation • Preauricular lymphadenopathy always occur
- 12. Acute Hemorrhagic Conjunctivitis •Acute conjunctivitis characterized by multiple conjunctival haemorrhages, conjunctival hyperaemia & mild follicular hyperplasia. • Caused by Picornaviruses (enterovirus type 70) • very contagious & transmitted by direct hand- to-eye contact
- 13. • Incubation period: 1-2 days • Symptoms • Pain • Redness • Watering • Mild photophobia • Transient blur of vision • Lid swelling • Signs • Conjunctival congestion • Chemosis • Multiple hemorrhage in bulbar conjunctiva • Mild follicular hyperplasia • Lid edema • Pre-auricular lymphadenopathy • Corneal sign : fine epithelial keratitis • Prophylactic measure similar to EKC. • Broad-spectrum antibiotic eyedrop. • Usually the disease has a self-limiting course of 7 days. • Supportive measure same as EKC. Treatment
- 14. Ophthalmia Neonatorum • Bilateralinflammation of the conjunctiva occurring in infant • Usually as a result of carelessness at the time of birth • Any discharge or even watering from the eyes in the first week of life should arouse suspicion of ophthalmia neonatorum, as tears are not formed till then • Causative agents • Gonococcal infection • Other bacterial infections • Staphylococcus aurues, Streptococcus haemolyticus, and Streptococcus pneumoniae • Neonatal inclusion conjunctivitis • Serotypes D to K of Chlamydia trachomatis • Herpes simplex-II virus
- 15. Clinical features • Painand tenderness in the eyeball • Conjunctival discharge o Purulent in gonococcal o Mucoid or mucopurulent in other bacterial cases and neonatal inclusion conjunctivitis o Lids are usually swollen o Eyelids and periocular vesicles may occur in HSV infection o Conjunctiva may show hyperaemia and chemosis
- 16. Treatment • Prophylaxis needsantenatal, natal and postnatal care. o Use either 1% tetracycline ointment or 0.5% erythromycin ointment into the eyes of babies immediately after birth are useful for preventing bacterial and chlamydial ophthalmia neonatorum. • Curative treatment Causative agents Treatment Gonococcal Needs prompt treatment to prevent complications 1. Topical therapy • Saline lavage hourly till discharge is eliminated • Bacitracin eye ointment 4 times/day • If cornea is involved, atropine sulphate ointment can be applied. 2. Systemic therapy • Ceftriaxone, cefotaxime, ciprofloxacin Other bacterial Treat with broad-spectrum antibiotics drops and ointment for 2 weeks • Neomycin-bacitracin, tobramycin Neonatal inclusion conjunctivitis Topical 1% tetracycline ointment or 0.5% erythromycin ointment qid for 3 weeks Systemic erythromycin (125 mg orally, qid for 3 weeks); presence of chlamydia agents in the conjunctiva implies colonization of URT as well. Herpes simplex Self-limiting However, antiviral drugs may control the infections and prevent the recurrence.