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Viral Conjunctivitis - Symptoms, Diagnosis, and Treatment

Published on Jan 27, 2022 and last reviewed on Nov 15, 2022   -  4 min read


Viral conjunctivitis is the most common cause for conjunctivitis, accounting for upto 75% of the cases. For more details, read the article below.

Viral Conjunctivitis - Symptoms, Diagnosis, and Treatment


Conjunctivitis (pink eye) is due to the inflammation of the conjunctiva, which is a thin semitransparent membrane that covers the sclera. It is due to a bacteria, virus, or allergy. Because the signs and symptoms are seen in other conditions also, a thorough medical and ophthalmic history with detailed examination is necessary for chronic patients. Viral conjunctivitis is the most common cause of it. It affects patients of all ages disregarding their socioeconomic status. The majority of the cases are self-limiting and do not cause any complications.

What Is Viral Conjunctivitis?

Viral conjunctivitis is often caused by adenovirus and is highly contagious. It can also be caused by the herpes simplex virus, varicella-zoster virus, picornavirus, poxvirus, infectious mononucleosis, and HIV (human immunodeficiency virus). Regardless of the etiology, conjunctivitis is categorized as either papillary or follicular based on the histologic appearance.

Epidemic keratoconjunctivitis is the most severe ocular infection caused by adenovirus. There is an immune response to viruses in the cornea (epidemic keratoconjunctivitis and subepithelial infiltrates) in these patients.

Acute hemorrhagic conjunctivitis is caused by the picornavirus and coxsackievirus variant. It mainly affects children and young adults in the lower economic class.

In the case of herpes zoster ophthalmicus, there is a reactivation of the varicella-zoster virus latent in the trigeminal ganglion.

Viral conjunctivitis is common in children, whereas adults are more susceptible to bacterial conjunctivitis. The virus can be transmitted through direct contact with the infected upper respiratory droplets, airborne transmission, or in reservoirs such as swimming pools. The infection usually begins in one eye, spreads to the other, and resolves within two to four weeks.

What Are the Symptoms of Viral Conjunctivitis?

  1. Intense pain and has a sandy or gritty feeling like something is in the eye.

  2. Redness, especially in one eye.

  3. Watery discharge in most cases but mucopurulent in case of herpes zoster infection.

  4. Severe sensitivity to light.

  5. Swollen conjunctiva.

  6. There are more tears than usual.

  7. Itchy and burning eyes.

  8. Blurred vision.

  9. Swollen lymph nodes.

Most of the patients with adenoviral conjunctivitis often give a history of recent exposure to an individual with red-eye. Along with these symptoms, there can be other associated symptoms such as pharyngoconjunctival fever (fever, inflammation of the pharynx and conjunctiva), malaise(general feeling of illness), and preauricular lymphadenopathy (swelling of the lymph nodes in front of the ears) in the case of adenovirus. Blister-like lesions in case of herpes simplex and viral rashes in rubella virus are seen. Sometimes, true or pseudomembrane can be seen. These are fibrin-rich exudates that are devoid of blood or lymph. Often the symptoms are mild, but when it is present in a newborn child or a person with a weakened immune system as of HIV, the symptoms can be severe. It needs immediate care.

How to Diagnose?

A comprehensive eye examination can diagnose conjunctivitis. It includes the following with a particular emphasis on the conjunctiva and surrounding tissues:

  • Patient history to know how and when the symptoms began.

  • Visual acuity measurements to determine whether the vision is affected.

  • Evaluating conjunctiva and other eye tissue under bright light and magnification.

  • In the case of chronic conjunctivitis, where the infection lasts longer than four weeks or when it is not responsive to the treatment, cultures or smears of the conjunctival tissue may help.

  • The gold standard for confirmation of adenovirus in cell culture, but the time taken is a disadvantage. In developed countries, the detection of viral DNA by polymerase chain reaction (PCR) is done. Recently, a rapid testing platform for adenovirus and AdenoPlus assay has also been developed. But the sensitivity is low compared to PCR.

What Is the Treatment for Viral Conjunctivitis?

Affected individuals are considered contagious until the resolution of conjunctivitis. The treatment aims to lessen the symptoms, reduce the duration, and prevent the spread of the infection. It usually resolves within two or three weeks. Symptoms can be relieved with cold compression on the periocular area with a wet washcloth and artificial tear solutions.

The use of Povidone-Iodine resulted in a reduction of the severity of the symptoms and reduced the recovery time. In epidemic keratoconjunctivitis, the visual symptoms related to the delayed immune response to the virus can be treated using Tacrolimus (immunosuppressive drug) or Cyclosporine A eye drops. If a true membrane or pseudomembrane is present, it can be peeled at the slit lamp. It can be done with a cotton swab soaked with a topical anesthetic to improve patient care and avoid scarring.

Like the common cold, the virus has to run its course until the infection clears off. Hence, antibiotics are not needed. Antiviral medication may be used to treat severe forms of conjunctivitis such as those associated with herpes simplex or varicella-zoster virus, newborn or immunocompromised individuals. Topical corticosteroids are avoided as they can prolong the virus shedding and infection. It is also suggested to avoid the use of contact lenses until the infection has cleared.

How to Prevent Viral Conjunctivitis?

  • Avoid contact with people who have viral conjunctivitis.

  • Maintain good hygiene measures such as washing your hands with soap or sanitizer.

  • Avoid touching the eyes when your hands are not clean.

  • Clean the spectacles.

  • Wash the pillowcases and towels, and do not share them with others.

  • Avoid sharing makeup items, eye drops, and swimming pools.

  • Affected individuals should refrain from work or school until their symptoms are resolved.

What Are the Complications?

  • Ulcers and inflammation of the cornea.

  • Scarring of the eye and blurred vision.

  • Bacterial superinfection.

  • Punctate keratitis.

  • Chronic infection.


The disease's contagious nature requires the infected individuals to be counseled to prevent transmission. While most of the causes of conjunctivitis are due to a virus, bacteria, or allergy, it can also be due to other reasons that include autoimmune disease (for example, uveitis, rheumatoid arthritis, etc.). The most recent isolated strain of coronavirus, covid-19, has been reported to cause conjunctivitis, but the transmission is not entirely understood.


Last reviewed at:
15 Nov 2022  -  4 min read




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