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.

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.

Causes

Adenoviruses are the most common cause of acute viral infections.

Differential Diagnoses

Melendez CP, Florentino MM, Martinez IL, Lopez HM. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents. Mol Vis. 2009. 15:557-62. [QxMD MEDLINE Link].
Dosso AA, Rungger-Brändle E. Clinical course of epidemic keratoconjunctivitis: evaluation by in vivo confocal microscopy. Cornea. 2008 Apr. 27(3):263-8. [QxMD MEDLINE Link].
Ishiko H, Aoki K. Spread of epidemic keratoconjunctivitis due to a novel serotype of human adenovirus in Japan. J Clin Microbiol. 2009 May 6. [QxMD MEDLINE Link].
Artieda J, Pineiro L, Gonzalez M, Munoz M, Basterrechea M, Iturzaeta A, et al. A swimming pool-related outbreak of pharyngoconjunctival fever in children due to adenovirus type 4, Gipuzkoa, Spain, 2008. Euro Surveill. 2009 Feb 26. 14(8):[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].
Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: pharmacology and clinical uses. Surv Ophthalmol. 2009 May-Jun. 54(3):321-38. [QxMD MEDLINE Link].
Chang CH, Lin KH, Sheu MM, et al. The change of etiological agents and clinical signs of epidemic viral conjunctivitis over an 18-year period in southern Taiwan. Graefes Arch Clin Exp Ophthalmol. 2003 Jul. 241(7):554-60. [QxMD MEDLINE Link].
D'Angelo LJ, Hierholzer JC, Keenlyside RA, et al. Pharyngoconjunctival fever caused by adenovirus type 4: report of a swimming pool-related outbreak with recovery of virus from pool water. J Infect Dis. 1979 Jul. 140(1):42-7. [QxMD MEDLINE Link].
Dawson CR, Sheppard JD. Follicular conjunctivitis In: Duane TA and Jaeger EW, eds. Duane's Clinical Ophthalmology. Vol. 4. 1989.
Diamante GG, Leibowitz HM. Superficial punctate keratopathy. In: Leibowitz HM and Waring GO, eds. Corneal Disorders: Diagnosis and Management. 2nd ed. 1998:432-479.
Liesegang TJ. Conjunctiva. In: Wright KW, ed. Textbook of Ophthalmology. 1997. 665-690.
McMillan NS, Martin SA, Sobsey MD, et al. Outbreak of pharyngoconjunctival fever at a summer camp -- North Carolina, 1991. JAMA. 1992. 267:2867-2868.
Nakayama M, Miyazaki C, Ueda K, et al. Pharyngoconjunctival fever caused by adenovirus type 11. Pediatr Infect Dis J. 1992 Jan. 11(1):6-9. [QxMD MEDLINE Link].
Pavan-Langston D. Viral diseases of the cornea and external eye. In: Albert DM, Jakobiec FA, eds. Principles and Practices of Ophthalmology. Vol. 1. 1994:117-161.
Reed DB. Viral and bacterial conjunctivitis. Prevention of disastrous results. Postgrad Med. 1989 Sep 15. 86(4):103-4, 107-9, 113-4. [QxMD MEDLINE Link].
Rietveld RP, van Weert HC, ter Riet G, Bindels PJ. Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search. BMJ. 2003 Oct 4. 327(7418):789. [QxMD MEDLINE Link].
Syed NA, Hyndiuk RA. Infectious conjunctivitis. Infect Dis Clin North Am. 1992 Dec. 6(4):789-805. [QxMD MEDLINE Link].
van Bijsterveld OP, de Jong JC, Muzerie CJ, Wermenbol AG. Pharyngoconjunctival fever caused by adenovirus type 19. Ophthalmologica. 1978. 177(3):134-9. [QxMD MEDLINE Link].
Enomoto M, Okafuji T, Okafuji T, Chikahira M, Konagaya M, Hanaoka N, et al. Isolation of an intertypic recombinant human adenovirus (candidate type 56) from the pharyngeal swab of a patient with pharyngoconjunctival fever. Jpn J Infect Dis. 2012. 65 (5):457-9. [QxMD MEDLINE Link].
Xie L, Yu XF, Sun Z, Yang XH, Huang RJ, Wang J, et al. Two adenovirus serotype 3 outbreaks associated with febrile respiratory disease and pharyngoconjunctival fever in children under 15 years of age in Hangzhou, China, during 2011. J Clin Microbiol. 2012 Jun. 50 (6):1879-88. [QxMD MEDLINE Link].

Media Gallery

of 0

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.

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, 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 Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue Received research grant from: Glaukos Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab stock options for: RPS, Fount Bio.

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

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, Association for Research in Vision and Ophthalmology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: 1-800-DOCTORS; AbbVie; Alcon; Aldeyra; Allergan; Alphaeon; ArcScan; Baush+Lomb; Bio-Tissue; Clearside; EyeGate; Hovione; Mededicus; NovaBay; Omeros; Pentavision; Portage; Santen; Science Based Health; Senju; Shire; Sun Pharma; TearLab;TearScience;Topivert Serve(d) as a speaker or a member of a speakers bureau for: AbbVie; Alcon; Allergan; Bausch+Lomb; Bio-tissue; EyeGate;Hovione;LayerBio; NovaBay;Omeros;Portage; Santen; Shire; Stemnion; Sun Pharma;TearLab;TearScience; Topivert Received research grant from: Alcon; Aldeyra; allergan; Baush+ Lomb; EyeGate; Hovione; Kala; Ocular Therapeutix;Pfizer; RPS; Santen;Senju;Shire;Topcon; Xoma.

Sections Pharyngoconjunctival Fever (PCF)
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
References

Pharyngoconjunctival Fever (PCF) Clinical Presentation

History

Physical

Causes

References

Tables

Contributor Information and Disclosures

What would you like to print?