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Viral Conjunctivitis Workup

  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Nov 05, 2015

Approach Considerations

Generally, a diagnosis of viral conjunctivitis is made on the clinical features alone. Signs of acute viral conjunctivitis include inferior palpebral conjunctival follicles, tender palpable preauricular lymph node, watery discharge, red and edematous eyelids, pinpoint subconjunctival hemorrhages, punctuate keratopathy, and membrane/pseudomembrane. Intraepithelial microcysts may be an early corneal finding, which, when present, is helpful in the diagnosis. Subepithelial corneal infiltrates may develop 1-2 weeks after the onset of the conjunctivitis. HSV infection may demonstrate the classic corneal dendrites.

Conventional laboratory identification can be expensive and time-consuming but may be helpful in certain circumstances.[3, 4, 5, 6]


Culture, Smear, and Stain

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

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 the use of immunoperoxidase, electron microscopy, and polymerase chain reaction (PCR) assay.

Serologic tests are available but generally require 2 serum samples at least 2 weeks apart, which can delay treatment.

Contributor Information and Disclosures

Ingrid U Scott, MD, MPH Professor, Department of Ophthalmology and Public Health Sciences, Pennsylvania State University College of Medicine

Ingrid U Scott, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, American Medical Association, American Society of Cataract and Refractive Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.


Kevin Luu, MD Consulting Staff, Pediatric Anesthesia Associates Medical Group, Inc; Consulting Staff, Children's Hospital of Central California

Kevin Luu, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Jerre Freeman, MD Founder and Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center College of Medicine

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, Tennessee Medical Association

Disclosure: Nothing to disclose.

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Viral conjunctivitis. Image courtesy of Wikimedia Commons.
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