Pharyngoconjunctival Fever Clinical Presentation

  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 29, 2012
 

History

  • Patients may give a history of recent exposure to an individual with red eye at home, school, or work, or they may have a history of recent symptoms of an upper respiratory tract infection.
  • PCF is characterized by its associated systemic manifestations. Patients experience a sudden or gradual onset of fever ranging from 100-104°F, lasting up to 10 days. Myalgia, malaise, and GI disturbances frequently are associated with the fever. The pharyngitis may be mild or quite painful.
  • Initial symptoms of conjunctivitis range from slight itching and burning to marked irritation and tearing, but little photophobia. Swelling of the lids may occur within 48 hours.
  • Signs of disease include epiphora, conjunctival hyperemia and chemosis, subconjunctival hemorrhage, follicular or mild papillary conjunctival reaction, and eyelid edema.
  • Mild crusting of the lids and discharge may occur; if present, it usually is serous.
  • PCF most frequently is bilateral, with one eye typically having onset 1-3 days prior to the second eye. With bilateral disease, the first eye generally is affected more severely.
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Physical

  • On general examination, look for a reddened posterior oropharynx covered with glassy follicles. Nontender cervical lymphadenopathy and tender, enlarged preauricular adenopathy may be present.
  • On ophthalmic examination, the conjunctivitis presents initially as a diffuse hyperemia that is generally more pronounced in the lower fornix but extends throughout the palpebral mucosa and onto the bulbar conjunctiva. It may be sufficiently boggy to give a slightly gelatinous appearance to the tissue.
  • The lower lid may be tender to palpation and ecchymotic, giving the appearance of recent ocular trauma. Conjunctival membranes and pseudomembranes are infrequent but may be present.
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Causes

Adenoviruses are the most common cause of acute viral infections.

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Contributor Information and Disclosures
Author

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, 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.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

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 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; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

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.

References

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  16. Rietveld RP, van Weert HC, ter Riet G, Bindels PJ. Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search. BMJ. Oct 4 2003;327(7418):789. [Medline].

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