The primary causes of viral conjunctivitis, which is also known as pink eye, are respiratory droplets that are airborne or via direct transfer from a person’s finger to the eyelid’s conjunctivital area. There will be an initial period wherein the virus incubates and this could last around 5 to 12 days.
After this incubation period, the patient will experience watery discharge, follicle formation and conjunctivital hyperemia as the disease enters the acute phase. During this time, lymphoid follicles will be markedly elevated.
It is very important to differentiate viral conjunctivitis or pink eye from other forms of conjunctivitis.
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While some viral infections can lead to severe vision problems, most will only produce a mild and self-limiting conjunctivitis. The two most common viral conjunctivitis forms that are self-limiting are epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever (PCF).
These two are highly contagious. In most cases, the source of the disease is through contact with another person who is suffering from upper respiratory infection or has red eyes. The disease will almost always start in just one eye before spreading to the other in a matter of days.
Furthermore, PCF is usually accompanied by a sore throat and fever. It usually lasts from 4 to 14 days. While the virus itself will probably be removed from the conjunctiva by the 14th day, it can remain in a patient’s fecal matter for up to around one month. The usual culprit is the adenovirus 3, though types 4 and 7 are also known to cause the disease.
The adenovirus types 8 or 19, on the other hand, can cause EKC. Corneal infiltrates are also common in EKC, although in rare instances, it may also characterize PCF.
Clinical Signs Viral Conjunctivitis (EKC and PCF).
The key signs of self-limiting viral conjunctivitis, particularly EKC and PCF, are the following:
• Conjunctival injection
• Edematous eyelids
• Preauricular lymph nodes
• Pseudomembrane formation
• Serous discharge
• Subconjunctival injection
In more serious instances, viral conjunctivitis can also cause scarring and symblepharon formation, which is the adherence of the palpebral conjunctivas and the bulbar.
Managing Conjunctivitis that is Self-Limiting
Here are some tips to remember to better manage this condition:
• As both EKC and PCF are highly contagious, patients are advised to remain at home until the discharges are completely gone.
• Personal items must not be shared with other people, like laundry clothes, beddings and linens, glasses and food utensils.
• EKC and PCF can also be treated medically. Artificial tears can be applied, as well as cold compresses. Topical vasoconstrictors, like naphazoline, can be used, although they can be responsible for prolonging the redness and conjunctivitis. Steroids, like Flarex, Pred forte and FML, can be administered twice up to four times daily.
• IMPORTANT POINT: Do not use Chlorsig eye drops. This very commonly used antibiotic in Australia, will potentially only prolong the redness and conjunctivitis due to it preservatives,
• In case there is a membrane present, the eye doctor can just peel it off using forceps or any wet applicator tipped with cotton. Topical antibiotic and steroid solutions, like Maxitrol or Tobradex, can then be applied.
• It must be noted that most anti viral drugs, such as Viroptic, are not effective in the treatment of these diseases. A drug called Cidofovir, however, has recently bucked the trend as it has been found to be effective. This topical medicine, applied twice a day, can create a viral DNA structure that is faulty, thus helping in the patient’s treatment.
• There also has been off label use of good old iodine. When viral conjunctivitis is first diagnosed many optometrists have had great success with using iodine diluted down to 2.5% concentration.
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