Conjunctivitis, Viral

http://emedicine.medscape.com/article/1191370-overview

Viruses are a common cause of conjunctivitis in patients of all ages. A variety of viruses can be responsible for conjunctival infection; however, adenovirus is by far the most common cause, and herpes simplex virus (HSV) is the most problematic. Less common causes include varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia), and human immunodeficiency virus (HIV). Rarely, conjunctivitis is seen during systemic infection with influenza virus, Epstein-Barr virus, paramyxovirus (measles, mumps, Newcastle), and rubella.

Picornaviruses cause an acute hemorrhagic conjunctivitis that is clinically similar to adenoviral conjunctivitis but is more severe and hemorrhagic. Infection is highly contagious and occurs in epidemics.

Acute hemorrhagic conjunctivitis has been reported in epidemics in association with 2 major picornaviruses, enterovirus 70 and Coxsackie A24. It mostly affects children and young adults in the lower socioeconomic classes. Patients experience a rapid onset of watery discharge, foreign body sensation, burning, and photophobia within 24 hours of exposure.

Topical steroids may be used for pseudomembranes or when subepithelial infiltrates impair vision, although subepithelial infiltrates may recur after discontinuing the steroids. Extreme caution should be taken when using corticosteroids, as they may worsen an underlying HSV infection.

Treatment of acute hemorrhagic conjunctivitis is supportive as in adenoviral infection and includes bed rest, cold compresses, and analgesics. Antibiotics have no useful role unless bacterial superinfection is present.