HEENT 15: Viral Conjunctivitis

Question 1

Describe the clinical presentation of viral conjunctivitis.

Answer 1

sudden onset of generalized redness, serous (watery) discharge, burning, foreign body sensation, and itching

• redness – diffuse, specific
• lymph nodes near ear
• may have light sensitivity

Question 2

Etiology

Answer 2

• adults > children
• contagious
• resolves within 1-2 weeks (antibiotics do not change this)
• both eyes (bilateral) within 24-48 hr of onset

Question 3

What are the causative pathogens of viral conjunctivitis? (7)

Answer 3

• adenovirus (major)
• enterovirus
• coxsackievirus
• VZV
• HSV
• Epstein-Barr virus
• influenzae

Question 4

What is the treatment for viral conjunctivitis?

Answer 4

mainly supportive with instructions on infection control

for alleviating symptoms:

• chilled artificial tears
• topical and systemic antiviral agents for HSV
• ocular decongestants/vasoconstrictors – short-term (< 3-4 times/month and < 3 days in a row)
• ophthalmic antihistamines – may help with severe itching, not indicated
• ophthalmic decongestants – may help with severe itching, not indicated

Question 5

Topical Vasoconstrictors/Decongestants (4)

Answer 5

• naphazoline – 1-2 drops q3-4h PRN x 3-4 days
• oxymetazoline – 1-2 drops q6h PRN x 3-4 days
• phenylephrine – 1-2 drops QID PRN x 3 days
• tetrahydrozoline – 1-2 drops BID-QID

Question 6

How long should topical vasoconstrictors/decongestants be used?

Answer 6

meant for short-term/occasional use – overuse may cause rebound hyperemia

Question 7

What are the adverse effects of topical vasoconstrictors/decongestants?

Answer 7

• minor stinging
• pupillary dilation
• angle-closure glaucoma (increase in IOP)