eMedicine Specialties > Ophthalmology > Conjunctiva

Conjunctivitis, Viral: Follow-up

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

Follow-up

Further Outpatient Care

  • Patients with conjunctivitis, especially those treated with medications, require follow-up care. Patients should return in 1-3 weeks or sooner if the condition significantly worsens.
  • Patients with conjunctivitis who wear contact lenses should be instructed to discontinue lens wear until signs and symptoms have resolved.

Deterrence/Prevention

  • Prevention of transmission, especially in health care facilities, is extremely important.
    • Careful hand washing before seeing every patient, proper cleansing of instruments, and frequent changing of multiuse ophthalmic drops are vital.
    • Using a single infective examination room, as well as educating the staff and the patient, is important.
  • Patients should be instructed to take contagion and isolation precautions for at least 2 weeks or as long as the eyes are red and weeping.

Complications

  • Complications include the following: punctate keratitis with subepithelial infiltrates, bacterial superinfection, corneal ulceration with keratoconjunctivitis, and chronic infection.
  • Epithelial keratitis may accompany viral conjunctivitis. Punctate epithelial erosions that stain with fluorescein characterize viral keratitis. Rarely, these changes are sufficiently distinctive morphologically to allow identification of a specific type of virus as the etiologic agent. If the conjunctivitis persists or is severe, disturbances in the anterior stroma beneath the epithelial abnormalities may occur. In general, the stromal or subepithelial abnormalities are transient and resolve despite persistence of epithelial keratitis. However, in cases of adenoviral infection, the stromal abnormalities may persist for months to years, long after the epithelial changes have resolved. In such cases, these subepithelial infiltrates are considered to be immunologic in origin, the result of antigen-antibody reaction. If they are in the pupillary axis, they may cause decreased vision and/or glare.

Prognosis

  • Most cases of viral conjunctivitis are acute, benign, and self-limited. The infection usually resolves spontaneously within 2-4 weeks. Subepithelial infiltrates may last for several months, and, if in the visual axis, they may cause decreased vision or glare.

Patient Education

  • To allay patient anxiety, it is helpful to inform patients that their symptoms may worsen during the first 4-7 days after onset before they begin to improve and may not resolve for 2-4 weeks. The contagiousness of the infection also should be emphasized. Proper isolation from work or school is advisable to prevent epidemics in the office and at school.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center and Skin, Hair, and Nails Center. Also, see eMedicine's patient education articles Pinkeye, How to Instill Your Eyedrops, and Molluscum Contagiosum.

Miscellaneous

Medicolegal Pitfalls

  • Physicians have been sued by patients who believe they acquired viral conjunctivitis in the doctor's office. Every attempt to prevent transmission from patient to patient (not to mention doctor) should be made. Suggestions include not having patients with a red eye wait in the general waiting room, having a special examination room for patients with red eye, disinfecting the examination room after seeing any patient with a red eye, not shaking hands with patients with red eye (after explaining the reason to them), touching their eyelids with cotton-tipped applicators and not your fingers, washing the hands immediately after examining the patient (even before writing in the chart), and not giving the chart to the patient to bring to the receptionist.

Special Concerns

  • Viral conjunctivitis is an occupational hazard of eye care physicians. Take all precautions possible not to become a victim.
 


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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