Definition
Conjunctivitis, or inflammation of the conjunctiva, is a prevalent cause of eye redness, affecting individuals of all ages. Approximately 75% of conjunctivitis cases are infection-related, predominantly caused by viruses. Viral conjunctivitis is highly contagious through indirect contact with contaminated objects like tears, mucus or eye secretions, contaminated hands, tissues, etc.
Causes
Viruses responsible for conjunctivitis include:
- Adenovirus, which accounts for 90% of viral conjunctivitis cases
- Rubella Virus
- Rubeola Virus
- Herpes Viruses:
- Herpes simplex virus (1.3–4.8% of viral conjunctivitis cases)
- Varicella-zoster virus
- Epstein-Barr virus
- COVID-19 can cause symptoms in both eyes, including eye redness and watery eyes, along with other systemic manifestations
Risk Factor
Several conditions increase the risk of viral conjunctivitis, including:
- Poor personal hygiene
- Improper contact lens use
- Living or working in crowded environments (e.g., schools, offices)
- History of other ocular diseases, such as dry eyes or blepharitis
- Recent eye surgery
- Immunocompromised
- Long-term use of ocular medications
Symptoms
Conjunctivitis symptoms in adults typically resolve without antibiotic treatment. However, antiviral medications are indicated for severe cases, such as those caused by the herpes simplex virus or the varicella-zoster virus. Symptoms of viral conjunctivitis include:
- Eye redness, particularly in the inner eyelids and sclera.
- Eye swelling.
- Excessive tearing.
- Thick, sticky discharge, especially upon waking, causes eyelid adhesion.
- Photophobia.
- Foreign body sensation in the eye.
- Swollen neck glands.
Additionally, viral conjunctivitis may present with:
- Upper respiratory infection, cold, or flu symptoms
- Pharyngoconjunctival fever, characterized by eye redness, watery eyes, fever, and sore throat, often due to adenovirus types 3, 4, and 7.
- Keratoconjunctivitis involving the cornea is typically caused by adenovirus types 8, 19, and 37.
- Herpetic conjunctivitis, caused by the herpes simplex virus, presents with painful periocular blisters and usually affects one eye.
- Rubella and rubeola-related symptoms such as rash, fever, and cough.
Symptoms generally persist for 4–7 days and are self-limiting. Due to the high contagion risk of viral conjunctivitis, maintaining strict personal hygiene is crucial to prevent transmission.
Diagnosis
Diagnosing conjunctivitis involves identifying the causative microorganism through medical history and physical examination. Additional tests are rarely necessary. If vision becomes increasingly blurred, a fluorescein examination may be conducted to detect corneal defects. Laboratory tests are indicated for cases persisting beyond four weeks.
Management
Medical Treatments
Viral conjunctivitis typically does not require treatment, as antibiotics are ineffective. For severe cases, corticosteroid drops may be prescribed to alleviate symptoms. Antiviral medications are used specifically for herpes virus or varicella-zoster virus-induced conjunctivitis, as they are not effective for other viral types.
Home Remedies
- To relieve symptoms, apply cold or warm compresses to the affected eye. Moisten a cloth with water and gently place it on the closed eye, avoiding pressure. Use a separate cloth for the healthy eye to prevent cross-infection. Compresses should be applied for 10-15 minutes, three times daily, ensuring no one else uses the cloth.
- Artificial tears from a pharmacy can help lubricate the eyes.
- Avoid contact lens use until fully recovered, and consider replacing lenses to prevent re-infection.
Complications
Viral conjunctivitis usually resolves within 1-2 weeks without complications. Severe cases, such as those caused by varicella-zoster or herpes simplex viruses, may result in corneal damage and potential blindness. In such instances, allergic conjunctivitis can progress to keratitis, involving the cornea and potentially impairing vision.
Prevention
Preventing viral conjunctivitis primarily focuses on minimizing transmission. The following measures are recommended:
- Regularly wash hands with soap or use hand sanitizer for at least 20 seconds, particularly before and after touching the eyes (e.g., when cleaning the eyes or applying eye drops)
- Refrain from touching your eyes
- Avoid sharing towels, bed sheets, and clothing with others, as the virus can spread through contact with contaminated items
- If possible, refrain from attending school or work for a few days to prevent infecting others
- Avoid swimming in public pools
- Wash and change towels and bed sheets after use
When to See a Doctor?
Viral conjunctivitis generally resolves with improved immunity and self-care. However, if symptoms persist beyond 2-4 weeks or if you experience eye pain, fever, or decreased vision, seek medical attention promptly.
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- dr Ayu Munawaroh, MKK
Conjunctivitis Information for Clinicians | CDC. (2021). Retrieved 31 October 2021, from https://www.cdc.gov/conjunctivitis/clinical.html#viral.
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Scott, IU. (2021). Viral Conjunctivitis (Pink Eye): Practice Essentials, Background, Etiology. Retrieved 31 October 2021, from https://emedicine.medscape.com/article/1191370-overview#a1.
How to Get Rid of Pinkeye. (2021). Retrieved 31 October 2021, from https://www.webmd.com/eye-health/pinkeye-home-care.