eMedicine Specialties > Ophthalmology > Conjunctiva

Conjunctivitis, Viral: Differential Diagnoses & Workup

Author: Ingrid U Scott, MD, MPH, Professor, Department of Ophthalmology and Public Health Sciences, Penn State College of Medicine
Coauthor(s): Kevin Luu, MD, Consulting Staff, Pediatric Anesthesia Associates Medical Group Inc; Consulting Staff, Children's Hospital Central California
Contributor Information and Disclosures

Updated: Aug 5, 2009

Differential Diagnoses

Conjunctivitis, Acute Hemorrhagic
Keratoconjunctivitis, Epidemic
Conjunctivitis, Allergic
Keratoconjunctivitis, Sicca
Conjunctivitis, Bacterial
Nasolacrimal Duct, Obstruction
Conjunctivitis, Giant Papillary
Pharyngoconjunctival Fever
Conjunctivitis, Neonatal
Red Eye Evaluation
Contact Lens Complications
Uveitis, Anterior, Nongranulomatous
Keratitis, Herpes Simplex
Keratoconjunctivitis, Atopic

Other Problems to Be Considered

HSV keratoconjunctivitis
VZV keratoconjunctivitis
Ocular chlamydial infections
Vernal keratoconjunctivitis
Blepharoconjunctivitis
Contact lens keratoconjunctivitis
Foreign body
Epithelial keratitis

Workup

Laboratory Studies

  • Generally, a diagnosis of viral conjunctivitis is made on the clinical features alone. Such findings include the classic corneal dendrites of HSV infection and follicular conjunctivitis, and preauricular adenopathy associated with adenoviral infection.
  • Conventional laboratory identification can be expensive and time-consuming but may be helpful in certain circumstances.3,4,5,6
  • Specimens should be obtained for culture and smear if inflammation is severe, in chronic or recurrent infections, with atypical conjunctival reactions, and with failure to respond to treatment.
    • Giemsa staining of conjunctival scrapings may aid in characterizing the inflammatory response. Polymorphonuclear cells are prevalent in bacterial infections, whereas mononuclear cells and lymphocytes are seen with viruses.
    • Viral isolation methods may be helpful in the diagnosis of acute follicular conjunctivitis, but they are not indicated in chronic conjunctivitis.
    • Direct immunofluorescence monoclonal antibody staining and enzyme-linked immunosorbent assay (ELISA) are rapid and widely available detection techniques.
    • Alternative methods include immunoperoxidase, electron microscopy, and polymerase chain reaction (PCR).
    • Serologic tests are available but generally require 2 serum samples at least 2 weeks apart, which can delay treatment.

More on Conjunctivitis, Viral

Overview: Conjunctivitis, Viral
Differential Diagnoses & Workup: Conjunctivitis, Viral
Treatment & Medication: Conjunctivitis, Viral
Follow-up: Conjunctivitis, Viral
References
Further Reading
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References

  1. Ishiko H, Shimada Y, Konno T, Hayashi A, Ohguchi T, Tagawa Y, et al. Novel human adenovirus causing nosocomial epidemic keratoconjunctivitis. J Clin Microbiol. Jun 2008;46(6):2002-8. [Medline].

  2. Kuo SC, Shen SC, Chang SW, Huang SC, Hsiao CH. Corneal superinfection in acute viral conjunctivitis in young children. J Pediatr Ophthalmol Strabismus. Nov-Dec 2008;45(6):374-6. [Medline].

  3. Park SW, Lee CS, Jang HC, et al. Rapid identification of the coxsackievirus A24 variant by molecular serotyping in an outbreak of acute hemorrhagic conjunctivitis. J Clin Microbiol. Mar 2005;43(3):1069-71. [Medline].

  4. Kimura R, Migita H, Kadonosono K, Uchio E. Is it possible to detect the presence of adenovirus in conjunctiva before the onset of conjunctivitis?. Acta Ophthalmol. Feb 2009;87(1):44-7. [Medline].

  5. Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. Am J Med Sci. Sep 2008;336(3):254-64. [Medline].

  6. Kaneko H, Maruko I, Iida T, Ohguchi T, Aoki K, Ohno S, et al. The possibility of human adenovirus detection from the conjunctiva in asymptomatic cases during nosocomial infection. Cornea. Jun 2008;27(5):527-30. [Medline].

  7. Monnerat N, Bossart W, Thiel MA. [Povidone-iodine for treatment of adenoviral conjunctivitis: an in vitro study]. Klin Monatsbl Augenheilkd. May 2006;223(5):349-52. [Medline].

  8. Boerner CF, Lee FK, Wickliffe CL, et al. Electron microscopy for the diagnosis of ocular viral infections. Ophthalmology. Dec 1981;88(12):1377-81. [Medline].

  9. Diamante GG, Leibowitz HM. Superficial punctate keratopathy. In: Leibowitz HM, Waring GO, eds. Corneal Disorders: Diagnosis and Management. 2nd ed. 1998:432-79.

  10. Jackson WB. Differentiating conjunctivitis of diverse origins. Surv Ophthalmol. Jul-Aug 1993;38 Suppl:91-104. [Medline].

  11. Lee SY, Pavan-Langston D. Role of acyclovir in the treatment of herpes simplex virus keratitis. Int Ophthalmol Clin. 1994;34(3):9-18. [Medline].

  12. Liesegang TJ. Conjunctiva. In: Wright KW, ed. Textbook of Ophthalmology. 1997:665-90.

  13. MMWR. Microsporidian keratoconjunctivitis in patients with AIDS. MMWR Morb Mortal Wkly Rep. Mar 23 1990;39(11):188-9. [Medline].

  14. Reed DB. Viral and bacterial conjunctivitis. Prevention of disastrous results. Postgrad Med. Sep 15 1989;86(4):103-4, 107-9, 113-4. [Medline].

  15. Syed NA, Hyndiuk RA. Infectious conjunctivitis. Infect Dis Clin North Am. Dec 1992;6(4):789-805. [Medline].

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Keywords

viral conjunctivitis, conjunctival infection, adenovirus, adenoviral conjunctivitis, epidemic keratoconjunctivitis, pinkeye, pink eye, pharyngoconjunctival fever, herpes simplex virus, HSV, ocular herpes simplex infection, follicular conjunctivitis, varicella-zoster virus, VZV, picornavirus, enterovirus 70, Coxsackie A24, hemorrhagic conjunctivitis, poxvirus, molluscum contagiosum, vaccinia, human immunodeficiency virus, HIV

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Contributor Information and Disclosures

Author

Ingrid U Scott, MD, MPH, Professor, Department of Ophthalmology and Public Health Sciences, Penn State College of Medicine
Ingrid U Scott, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Macula Society, Phi Beta Kappa, and Retina Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kevin Luu, MD, Consulting Staff, Pediatric Anesthesia Associates Medical Group Inc; Consulting Staff, Children's Hospital Central California
Kevin Luu, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Jerre Freeman, MD, Founder, Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center
Jerre Freeman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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