Viral Conjunctivitis

Epidemiology: The incidence of epidemic keratoconjunctivitis is high in general, and it is by far the most frequently encountered viral conjunctivitis (see Table 4.2).

Fig. 4.14 Prominent tarsal follicles and papillae on the upper and lower eyelids.

Inflamed Lacrimal Caruncle

Etiology: This highly contagious conjunctivitis is usually caused by type 18 or 19 adenovirus and is spread by direct contact (see also prophylaxis; Figs. 4.15 a and b). The incubation period is eight to ten days.

Symptoms: Onset is usually unilateral. Typical signs include severe illacri-mation and itching accompanied by a watery mucoid discharge. The eyelid and often the conjunctivitis are swollen. Patients often also have a moderate influenza infection.

Diagnostic considerations: Characteristic findings include reddening and swelling of the plica semilunaris and lacrimal caruncle and nummular keratitis (Fig. 4.15b) after 8-15 days, during the healing phase.

— Epidemic keratoconjunctivitis (viral conjunctivitis).

— Epidemic keratoconjunctivitis (viral conjunctivitis).

Lacrimal Caruncle Swelling

a Acute unilateral reddening of the conjunctiva accompanied by pseudoptosis.

b After 8-10 days coin-like infiltrates (nummular keratitis) appear in the superficial corneal stroma. These may persist for months or years.

a Acute unilateral reddening of the conjunctiva accompanied by pseudoptosis.

b After 8-10 days coin-like infiltrates (nummular keratitis) appear in the superficial corneal stroma. These may persist for months or years.

Differential diagnosis: The disease runs a well defined clinical course that is nearly impossible to influence and resolves after two weeks. No specific therapy is possible. Treatment with artificial tears and cool compresses helps relieve symptoms. Cortisone eyedrops should usually be avoided as they can compromise the immune system and prolong the clinical symptoms.

Prophylaxis: This is particularly important. Because the disease is spread by contact, the patient should refrain from rubbing his or her eyes despite a severe itching sensation and avoid direct contact with other people such as shaking hands, sharing tools, or using the same towels or wash cloths, etc.

Special hygiene precautions should be taken when examining patients with epidemic keratoconjunctivitis in ophthalmologic care facilities and doctors' offices to minimize the risk of infecting other patients. Patients with epidemic keratoconjunctivitis should not be seated in the same waiting room as other patients. They should not be greeted with a handshake, and they should be requested to refrain from touching objects where possible. 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.

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