An Update on Viral Conjunctivitis

    • CE credits 2 hours
    • COPE code 60364-AS / 116667
    • Available until Dec 20, 2021


Learning Objectives

  • To review the various viruses that are capable of causing conjunctivitis
  • To review the typical clinical presentation, course and potential complications of viral conjunctivitis
  • To review recent literature on a potential novel treatment for viral conjunctivitis


A 34 year old female with no past medical or ocular history presents to the eye clinic with a red right eye which has been present for the last 48 hours. Approximately 4-5 days ago, she began having symptoms of a cold and this was later followed by the red eye. The eye is not painful or itchy and she reports no visual symptoms. She says most of the discharge is watery, although this morning she did feel her lids “crusted together”.

On exam, best-corrected visual acuity is 20/20 bilaterally. A tender right pre-auricular node is palpable. External exam of the right eye is shown below. (On slit lamp exam multiple follicles are seen on the inferior conjunctiva. There are also sparse subepithelial infiltrates of the cornea, with no fluorescein staining of the corneal epithelium. Posterior segment exam is normal).

Quick Question

What is the most likely etiology of this red eye?

  • Allergic conjunctivitis

    Although allergic conjunctivitis can appear similar, it is often characterized by profound itchiness. In addition, the recent upper respiratory tract infection and lack of allergy-related history and symptomology makes this less likely.

  • Adenovirus


  • Enterovirus

    Enterovirus is a cause of viral conjunctivitis, specifically acute hemorrhagicconjunctivitis which is characterized by sudden onset and severe conjunctivitis often with subconjunctivalhemorrhages. The lack of subconjunctivalhemorrhages makes this less likely. (In addition), acute hemorrhagic conjunctivitis is more likely to be seen in developing countries.

  • Bacterial conjunctivitis

    The lack of purulent discharge makes bacterial conjunctivitis less likely, although differentiating viral vs. bacterial conjunctivitis is often difficult in the clinical setting. In addition the upper respiratory symptoms in keeping with a “cold” as well as the preauricular node are more in keeping with a viral picture.


Conjunctivitis is an extremely common condition caused by infection or inflammation of the conjunctiva.2 As a whole, conjunctivitis is the most frequent ocular disorder encountered in ophthalmic clinics, with viral causes accounting for roughly 62% of all such cases. Viral conjunctivitis is most commonly caused by adenoviral species, however a broad range of viral species may cause thiscondition. It commonly affects younger age groups, although individuals of all ages are susceptible. It exhibits no sexual predilection.

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