This document discusses conjunctival viral infections, summarizing: 1) Adenovirus is the most common cause, responsible for over 90% of cases, and can cause nonspecific acute follicular conjunctivitis, pharyngoconjunctival fever, or epidemic keratoconjunctivitis. 2) Other causes include herpes simplex, herpes zoster, enteroviruses, poxviruses, cytomegalovirus, and molloscum contagiosum. 3) Symptoms vary but generally include redness, irritation, watering and photophobia, while signs involve eyelid edema and conjunctival hyperemia and follicles.

1. CONJUNCTIVAL VIRAL INFECTIONS

2. Introduction:-
• Common external ocular infection.
• In 90% cases, Adenovirus is the causative agent.
• May be sporadic ,or occur in epidemics.

3. Causative Agents:-
• Adenovirus conjunctivitis(>90% cases).
• Herpes simplex keratoconjunctivitis.
• Herpes zoster conjunctivitis.
• Acute Haemorrhagic conjunctivitis(Enterovirus 70 and coxsackie virus).
• Poxvirus conjunctivitis.
• Cytomegalovirus infections.
• Moluscum contagiosm.

4. • Myxovirus conjunctivitis; following influenza, parainfluenza,
measles and Newcastel disease.
• Paramyxovirus conjunctivitis.
• ARBOR virus conjunctivitis Corona virus conjunctivitis including COVID
19.

5. Symptoms:-
• Watering
• Redness
• Irritation
• Itching
• Photophobia (When Cornea is involved).

6. Signs
• Eyelids :
Edema, ranging from mild to severe.
• Lymphadenopathy : Common tender pre-auricular nodes.
• Conjunctiva:
Hyperemia, Follicles.

7. • Severe Inflammation:
May be associated with conjunctival haemorrhage, chemosis,
membranes(rare) and pseudomembranes.
Sometimes conjunctival scarring.
• Keratitis(Adenoviral):
Epithelial microcysts in the early stage.

8. • Punctate epithelial keratitis:
Usually occur in 7-10 days of onset of symptoms.
Resolving in 2 weeks.
• Anterior Stromal infiltrates/SEI: may persist for months or years.
• Anterior uveitis: Usually mild.

9. Adenoviral Conjunctivitis
• Non-enveloped,
• Double stranded DNA viruses,
• Replicate within the nucleus of host cells.
• General reservoir is only human.

10. Spread of infection:-
• Facilitated by :
i)Virus can survive on dry surfaces for weeks.
ii)Viral shedding may occur for many days before clinical features are
apparent.
• Transmission by:
i)Contact with respiratory or ocular secretions.
ii)Via contaminated fomites such as towels.
iii)Route of transmission is usually eye-hands-eyes.
• In clinical settings, eye-instruments-eye.

11. Type of adenoviral conjunctivitis:-
• Nonspecific acute follicular conjunctivitis
• Pharyngoconjunctival fever (PCF)
• Epidemic keratoconjunctivitis (EKC)
• Chronic /relapsing adenoviral conjunctivitis

12. Nonspecific acute follicular conjunctivitis:
• Most common form.
• Caused by serotype 1 to 11 and 19.

13. Pharyngoconjunctival fever (PCF)
• Acute follicular conjunctivitis with pharyngitis.
• Occour as outbreaks in children summer camps(causing swimming
pool conjunctivitis).
• Associated with adenovirus type3 and 7.
• Cornea : superficial punctate keratitis. (30%)

14. Epidemic keratoconjunctivitis (EKC)
• Most severe presentation.
• Caused by adenoviruses type 8,19 and 37.
• Occour mainly in adults.
• Mostly associated with keratitis and preauricular lymphadenopathy.
• Markedly contagious.
• Incubation period after infection (8 days) & virus shed from the
inflamed eye for 2-3 weeks.
• Keratitis occurs in 80% cases.

15. Chronic/relapsing adenoviral conjunctivitis
• Rare
• Gives a clinical picture of chronic non-specific
follicles/ papillas.
• Can persist over years, but eventually self limiting.

16. Herpes simplex Virus:-
• Causes Follicular conjunctivitis particularly in primary disease.
• Usually unilateral.
• Often Associated skin lesions.
• Minute, micro dendrites may be mistaken for punctate epithelial
keratitis, but corneal sensation is reduced in HSV.

17. Zoster ophthalmicus
• Caused by infection of gasserian ganglion of fifth cranial nerve by
Varicella-zoster virus.
• Constitute almost 10% cases of zoster.
• Mucopurulent conjunctivitis.

18. Acute Haemorrhagic conjunctivitis:-
• Caused by Enterovirus A and coxsackie virus(Picorna
virus family).
• Extremely contagious.
• In acute inflammation conjunctiva characterised by conjunctival
haemorrhage, hyperaemia and mild follicular hyperplasia.
• Usually occurs in tropical areas.
• Rapid onset, resolves within 1-2 weeks.

19. MOLUSCUM CONTAGIOSM
• ds- DNA pox virus.
• Typically affects otherwise healthy individuals.
• Peak incidence between 2 to 4 years of age.
• Lesions on lid margins may shed virus into tear film giving rise to
secondary ipsilateral chronic follicular conjunctivitis.

20. NEWCASTLE DISEASE (CONJUNCTIVITIS)
• Rare type
• Caused by avian parainfluenza virus – called as Newcastle disease
virus (or Ranikhet virus in India)
• Occours in pollutary workers.
• Mild self limiting conjunctivitis.

21. Cytomegalovirus
• Cause mild unilateral catarrhal conjunctivitis.
• Most frequent ocular opportunistic infection with patients with AIDS.

22. Systemic viral infections causing
conjunctivitis:-
• Measles ,
• Mumps ,
• Varicella ,
• HIV etc.

23. Investigations:-
• Giemsa stain:
Shows predominantly mononuclear cells in Adenovirus infection and ,
Multinuclear giant cells in herpetic infections.

24. • PCR
• Viral culture: 100% specific but slow and requires specific transport
medium.
• Immunochromatography.
• Serology: detection of IgG and IgM

25. ADENOVIRAL CONJUNCTIVITIS TREATMENT :-
• Supportive treatment for amelioration of symptoms is the only
treatment required and includes:
• Artificial tears preferably preservative free.
• Topical Anti Histamines and vasoconstrictors.
• Cold Compresses
• Discontinuation of contact lens wear.

26. • Removal of membranes/pseudo membranes.
• Topical antibiotics.
• Povidone-Iodine: kills free adenoviruses.
• Topical Steroids: For severe membranous or pseudo-membranous
conjunctivitis and SEIs.

27. Reduction of Transmission Risk:-
• Hand hygiene.
• Avoiding eye rubbing and towel sharing.
• Disinfection of instruments and clinical surfaces after examining an
infected person.

28. Acute Haemorrhagic Conjunctivitis
Treatment:-
• Prophylactic measures similar to EKC.
• Supportive measures same as Adenoviral.
• Usually the disease has a self-limiting course of 7 days.

29. Herpes Simplex Treatment:-
• Usually self limiting.
• Topical antiviral drugs control the infection effectively and prevent
recurrences.
• Supportive measures are similar with Adenoviral.

30. Moluscom Treatment
• Usually the lesion is self-limiting in immunocompetent patient.
• Removal is needed to address secondary Conjunctivitis or for
Cosmetic reasons.
• Expression by making a nick in the skin by a needle is usually
effective.

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