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Acute Hemorrhagic Conjunctivitis Clinical Presentation

  • Author: George Plechaty, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Mar 20, 2015


Acute hemorrhagic conjunctivitis (AHC) is a rapidly progressive and contagious viral infection.[8, 9]

AHC begins with an initial period of catarrhal inflammation.[10, 11] The presentation becomes more dramatic with the rapid appearance of conjunctival petechiae. These conjunctival petechiae soon coalesce to form subconjunctival hemorrhages. These are associated with a painful, rapidly progressive follicular conjunctivitis. The lids often become swollen and indurated. The infection resolves within 5-7 days, during which the symptoms of pain and irritation are present.

Punctate corneal epithelial defects have been noted and subepithelial corneal opacities have been described.

The most common manifestation of enteroviral infection is a low-grade fever of unknown etiology in infants. While concerned mainly with conjunctivitis here, it should be noted that numerous organ systems can be involved. They range from the myocardium to the central nervous system and can also include the respiratory system and the skin.


Physical Examination

The presentation of acute hemorrhagic conjunctivitis (AHC) can be dramatic. Findings include swollen lids, conjunctival follicles, chemosis, and, depending on the stage at which the patient is seen initially, subconjunctival hemorrhages, which can range from petechiae to large areas of conjunctival involvement. The cornea can exhibit superficial epithelial changes.

The symptoms also include are pain and irritation, and the lids and periocular tissues present with marked inflammation.

Contributor Information and Disclosures

George Plechaty, MD Clinical Assistant Professor, Department of Surgery, Division of Ophthalmology, University of Hawaii, John A Burns School of Medicine

George Plechaty, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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 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

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

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Secondary corneal ulcer in a case of acute hemorrhagic conjunctivitis treated with steroids.
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