Guidelines Summary

Recommendations for urgent and nonurgent patient care in ophthalmology were published in 2020 by the American Academy of Ophthalmology (AAO).^{[12, 13]}

Owing to the COVID-19 pandemic, all ophthalmologists should immediately cease providing any treatment other than urgent or emergent care.

Several reports suggest COVID-19 can cause conjunctivitis and possibly be transmitted by aerosol contact with conjunctiva.

Patients with conjunctivitis frequently present to eye clinics or emergency departments; therefore, ophthalmologists may be the first clinicians to examine patients who could have COVID-19.

Prior to examination, ophthalmologists should ask patients if they have a fever or respiratory symptoms and if they or their family members have traveled recently.

Ophthalmologists must take necessary safety precautions while caring for patients who may have COVID-19. This includes wearing protection for the mouth, nose, and eyes; using slit-lamp barriers or breath shields; and continuing to use the same disinfection practices already used to prevent office-based spread of viral pathogens.

Ophthalmologists should use disposable tonometer tips when checking intraocular pressure, as the virus has been found in the tears of some patients with conjunctivitis.

The American Academy of Ophthalmology has no opinion on the systemic safety or efficacy of COVID-19 treatments currently under investigation.

Medication

Sambursky R, Trattler W, Tauber S, Starr C, Friedberg M, Boland T, et al. Sensitivity and Specificity of the AdenoPlus Test for Diagnosing Adenoviral Conjunctivitis. JAMA Ophthalmol. 2013 Jan 1. 131(1):17-21. [QxMD MEDLINE Link].
Kam KY, Ong HS, Bunce C, Ogunbowale L, Verma S. Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study. Br J Ophthalmol. 2015 Sep. 99 (9):1186-9. [QxMD MEDLINE Link].
Ishiko H, Shimada Y, Konno T, Hayashi A, Ohguchi T, Tagawa Y, et al. Novel human adenovirus causing nosocomial epidemic keratoconjunctivitis. J Clin Microbiol. 2008 Jun. 46(6):2002-8. [QxMD MEDLINE Link].
Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23. 310 (16):1721-9. [QxMD MEDLINE Link].
Kuo SC, Shen SC, Chang SW, Huang SC, Hsiao CH. Corneal superinfection in acute viral conjunctivitis in young children. J Pediatr Ophthalmol Strabismus. 2008 Nov-Dec. 45(6):374-6. [QxMD MEDLINE Link].
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. 2005 Mar. 43(3):1069-71. [QxMD MEDLINE Link].
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. 2009 Feb. 87(1):44-7. [QxMD MEDLINE Link].
Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. Am J Med Sci. 2008 Sep. 336(3):254-64. [QxMD MEDLINE Link].
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. 2008 Jun. 27(5):527-30. [QxMD MEDLINE Link].
Wilkins MR, Khan S, Bunce C, et al. A randomised placebo-controlled trial of topical steroid in presumed viral conjunctivitis. Br J Ophthalmol. 2011 Sep. 95(9):1299-303. [QxMD MEDLINE Link].
Monnerat N, Bossart W, Thiel MA. [Povidone-iodine for treatment of adenoviral conjunctivitis: an in vitro study]. Klin Monatsbl Augenheilkd. 2006 May. 223(5):349-52. [QxMD MEDLINE Link].
American Academy of Ophthalmology. Alert: Important coronavirus updates for ophthalmologists. Available at https://www.aao.org/headline/alert-important-coronavirus-context. March 22, 2020; Accessed: March 23, 2020.
Parry N. AAO Releases COVID-19 Updates for Ophthalmologists. Medscape Medical News. Available at https://www.medscape.com/viewarticle/926365. March 6, 2020;
Keller DM. Rapid Tests Diagnose Dry Eye, Adenovirus Conjunctivitis. Medscape Medical News. January 15, 2013. Available at http://www.medscape.com/viewarticle/777710. Accessed: January 23, 2013.
Usher P, Keefe J, Crock C, Chan E. Appropriate prescribing for viral conjunctivitis. Aust Fam Physician. 2014 Nov. 43 (11):748-9. [QxMD MEDLINE Link].

Media Gallery

Viral conjunctivitis. Image courtesy of Wikimedia Commons.

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Author

Ingrid U Scott, MD, MPH Jack and Nancy Turner Professor of Ophthalmology, Professor of Public Health Sciences, Penn State Eye Center, 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, Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin Luu, MD Consulting Staff, US Anesthesia Partners, Inc, Medical City Dallas Hospital

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, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, 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, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

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.

Sections Viral Conjunctivitis (Pink Eye)
Overview
Presentation
DDx
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Treatment
Guidelines
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Viral Conjunctivitis (Pink Eye) Guidelines

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