Version 6

Condition / Conjunctivitis (viral, non-herpetic) without corneal involvement
Aetiology / Adenovirus (more than 30 serotypes)
- commonest form of acute infective conjunctivitis
- spectrum of disease varies from mild to severe
- two syndromes of adenoviral infection:
- pharyngoconjunctival fever (not dealt with in this Guideline)
- epidemic conjunctivitis (this Guideline) and keratoconjunctivitis
Enterovirus 70
- acute haemorrhagic conjunctivitis (rare)
Predisposing factors / Recent cold or other upper respiratory tract infection
Low standards of hygiene
Crowded conditions (schools, camps, clinics)
Eye clinics (transmission by clinicians’ fingers, tonometer prisms, etc.)
Symptoms / Acute onset
- redness
- discomfort, usually described as burning or grittiness
- watering
Eyelids may be stuck together in the morning and have to be bathed open
Often initially unilateral, becoming bilateral, first eye usually more affected
Possible history of preceding upper respiratory tract infection, low grade fever
Signs / Watery discharge
Conjunctival hyperaemia (may be intense)
Follicles on palpebral conjunctiva, especially upper and lower fornix (if abundant, follicles can produce folds)
Petechial (pin-point) subconjunctival haemorrhages
Pseudomembranes on tarsal conjunctival surfaces (severe cases only)
Pre-auricular lymphadenopathy (may be tender)
Corneal involvement may be present: see separate Guideline
Differential diagnosis / Other forms of conjunctivitis
- bacterial
- Chlamydial
- Herpes (simplex or zoster)
- allergic
Other causes of acute red eye
- angle closure glaucoma
- keratitis
- anterior uveitis
Management by Optometrist
Non- pharmacological / Wash hands carefully before and after examination
Do not applanate as condition highly contagious
Advise patient
-  condition is normally self-limiting, resolving within two to three weeks
-  condition is highly contagious for family, friends and work colleagues (do not share towels, etc)
-  confirmed infection necessitates 2 weeks off work or school
Review to monitor for appearance of corneal signs
Pharmacological / Antibacterial agents not effective in viral conditions
Current anti-viral agents also ineffective in adenovirus infection
Artificial tears (eg gutt. hypromellose) ± unmedicated ointment (eg oc Lacri-lube) if needed for symptomatic relief
Management
category / B2: alleviation/palliation; normally no referral
A2: first aid measures and urgent referral if conjunctivitis severe (eg presence of pseudomembrane) or if keratitis present
Management by Ophthalmologist

Conjunctival swabs for virus isolation and strain identification

Topical steroid in severe cases