Download - Viral Conjunctivitis
VIRAL CONJUNCTIVITIS
PGI Maria Joane Faye C. Lim
VIRAL CONJUNCTIVITIS
Most common type of conjunctivitis worldwide
Adenovirus is the most common cause of viral
conjunctivitis
Usually benign and self-limited
Longer course (2-4weeks) than acute bacterial
conjunctivitis
Characterized by acute follicular conjunctival reaction and
preauricular adenopathy
PATHOPHYSIOLOGY
ACUTE PHASE: watery discharge, conjunctival hyperemia, follicle formation
INCUBATION PHASE (5-12days)
Airborne respiratory droplets or direct transmission to conjunctival surface
VIRUS
PROMINENT TARSAL FOLLICLES AND PAPILLAE ON THE UPPER AND LOWER
EYELIDS
ADENOVIRAL CONJUNCTIVITIS
Epidemic keratoconjunctivitis
Pharyngoconjunctival fever
EPIDEMIC KERATOCONJUNCTIVITIS
Etiology: This highly contagious conjunctivitis is
usually caused by type 8 or 19 adenovirus and is
spread by direct contact
Incubation period: 8 to 10 days
usually bilateral
MANIFESTATIONS
Preauricular adenopathy
Epiphora
Hyperemia
Chemosis
Follicular conjunctival reaction
Pseudomembranous conjunctival reaction
Corneal epithelial defect (in severe cases)
THICK WHITE MEMBRANE OF UPPER PALPEBRAL CONJUNCTIVA
EPIDEMIC KERATOCONJUNCTIVITIS
Diagnostic considerations: Characteristic findings
include reddening and swelling of the plica
semilunaris and lacrimal caruncle and nummular
keratitis after 8–15 days, during the healing phase.
EPIDEMIC KERATOCONJUNCTIVIT IS
Acute unilateral reddening of the conjunctiva accompanied
by pseudoptosis.
COIN-LIKE INFILTRATES (NUMMULAR KERATITIS) APPEAR IN THE SUPERFICIAL
CORNEAL STROMA
PHARYNGOCONJUNCTIVAL FEVER
characterized by fever of 38.3–40 °C, sore throat,
and a follicular conjunctivitis in one or both eyes
The syndrome may be incomplete, consisting of
only one or two of the cardinal signs (fever,
pharyngitis, and conjunctivitis).
caused regularly by adenovirus 3 and 7
Usually lasts for 10 days
MANIFESTATIONS
Prominent follicles on conjunctiva and pharyngeal
mucosa
Injection
Tearing
Transient superficial epithelial keratitis
Subepithelial opacities
Nontender preauricular lymphadenopathy
HERPES SIMPLEX CONJUNCTIVITIS
Unilateral injection, irritation, mucoid discharge, photophobia
Usually associated with Herpes simplex keratitis • dendritic keratitis with typical features of linear
branching and dendritic figures
Cytology: mononuclear cells
Usually self limited
MANIFESTATIONS
Vesicles on the eyelid or face
Swollen eyelids
Ulcerative blepharitis
OCULAR HERPES
VARICELLA-ZOSTER VIRUS
generalized vesicular eruption, fever, and
constitutional symptoms.
unilateral
presents as small, papular lesions that erupt along
the lid margin or at the limbus and may be
accompanied by a mild follicular conjunctivitis
Scrapings may contain: giant cells and monocytes
HERPES ZOSTER OPHTHALMICUS
reactivation of latent VZV infection of the trigeminal
ganglion
prodrome of fever, malaise, nausea, vomiting, and severe
pain and skin lesions along the ophthalmic division of the
trigeminal nerve
Conjunctival involvement includes hyperemia, follicular or
papillary conjunctivitis, and a serous or mucopurulent
discharge, multiple fine, dendritic corneal lesions
PICORNAVIRUS
Enterovirus 70 and Coxsackievirus A24
Acute hemorrhagic conjunctivitis
Mostly affects children and young adults in lower
socioeconomic class
rapid onset of watery discharge, foreign body
sensation, burning, and photophobia within 24 hours
of exposure
ACUTE HEMORRHAGIC CONJUNCTIVITIS
TREATMENT
Supportive management• Cold compress• Lubricants
VZV infection• Acyclovir, 600-800 mg, 5 times daily for 7-10 days
HSV infection• idoxuridine solution and ointment, vidarabine
ointment, and trifluridine solution
PROPHYLAXIS
refrain from rubbing eyes despite severe itching sensation
avoid direct contact with other people
Patients with epidemic keratoconjunctivitis should not be
seated in the same waiting room as other patients.
Examination should be by indirect means only, avoiding
applanation tonometry, contact lens examination, or gonioscopy.
After examination, the examiner should clean his or her hands
and the work site with a surface disinfectant.
AN ANTIVIRAL SMALL-INTERFERING RNA SIMULTANEOUSLY
EFFECTIVE AGAINST THE MOST PREVALENT ENTEROVIRUSES
CAUSING ACUTE HEMORRHAGIC CONJUNCTIVITIS
F R O M T H E D E PA R T M E N T S O F M I C R O B I O L O G Y, O P H T H A L M O L O G Y, A N D B I O - M E D I C A L I N S T I T U T E
O F T E C H N O L O G Y, U N I V E R S I T Y O F U L S A N C O L L E G E O F
M E D I C I N E ; A N D 4 A S A N M E D I C A L C E N T E R , S E O U L , K O R E A
A U G U S T 3 , 2 0 1 0
Eun Jung Jun, Min Ah Won, Jeonghyun Ahn,
Ara Ko, Haein Moon, Hungwon Tchah, Yoo
Kyum Kim, and Heuiran Lee
PURPOSE
To develop a novel small interfering RNA-
based anti-AHC agent effective against both EV70
and CVA24.
METHODOLOGY
Concurrent screening of the entire viral
genome sequences of EV70 and CVA24 using the
CAPSID program identified five different siRNA
candidates complementary to genome regions of both
viruses. The antiviral potentials of these siRNAs were
assessed by treating MRC5 and primary human
conjunctival cells with the siRNAs and following this
with viral challenge.
Data were explored by ANOVA making use of the
SPSS program and were next compared using the
paired t-test or descriptive statistics
RESULT
Among the five siRNAs, AHCe-3D-3
siRNA showed excellent cytoprotective effects and
dramatic decreases in virus replication and virus
protein synthesis. This siRNA, targeting the virus
polymerase 3D gene, also induced similar antiviral
effects in primary human conjunctival cells.
CONCLUSION
The AHCe-3D-3 siRNA can provide
equivalent antiviral activities against enterovirus 70
and coxsackievirus A24. Such an siRNA may be
developed as a clinically valuable AHC control agent.