viral Conjunctivitis: Understanding the Gritty Eye Trouble

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Eye with pink or red conjunctiva_ Eye with pink or red conjunctiva, a symptom of viral conjunctivitis.

Introduction: 

Conjunctivitis is a common cause of red eyes that affects people of all ages and socioeconomic backgrounds. Viral conjunctivitis accounts for the majority of cases, accounting for up to 75%. Symptoms of viral conjunctivitis include redness, swelling of blood vessels, eye discharge, pain, sensitivity to light, and formation of pseudomembranes. The economic and social impact of conjunctivitis is significant, with costs associated with visits to health care providers, diagnostic tests, medications, and reduced productivity from work or school.

Antibiotic prescriptions for viral conjunctivitis contribute substantially to healthcare costs. In the UK, 80% to 95% of patients with infectious conjunctivitis receive antibiotic treatment. Improvements in the diagnosis of viral conjunctivitis have reduced inappropriate antibiotic use, saving approximately US$430 million annually in the United States. Clinical trials are underway to develop specific treatments for viral conjunctivitis. Because of the nonspecific nature of the symptoms, a comprehensive medical and ophthalmic history, along with a thorough physical examination, is essential, especially for patients with atypical or prolonged symptoms.

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What is Viral Conjunctivitis (Pink Eye)

Conjunctivitis, commonly known as pink eye, is characterized by inflammation of the conjunctiva, the thin membrane covering the inner surface of the eyelids and the white part of the eyeball. This inflammation causes the small blood vessels in the conjunctiva to become inflamed and inflamed, causing the eyes to appear red or pink.

Pink eye can be caused by a variety of factors, including a viral or bacterial infection, an allergic reaction, or, in infants, an underdeveloped tear duct. Although it can be painful, pink eye usually does not significantly affect vision. Treatments are available to ease symptoms, and early diagnosis and precautions are essential to prevent its spread, as it can be contagious.

Close-up of an eye with redness, watering, and irritation_ Close-up of an eye with viral conjunctivitis, showing redness, watering, and irritation.

Causes of Viral Conjunctivitis?

Viral conjunctivitis, which is often short-lived, is primarily caused by viral infections, with the adenovirus family being the main culprit. Adenoviruses cause upper respiratory infections that resemble the common cold or flu.

Many other viruses can also cause pink eye. Symptoms include redness of the white of the eye or the inside of the eyelid, watery eyes, an itchy or scratchy feeling in the eye, sensitivity to light, swollen eyelids, and a discharge from the eye, which may be clear or white.

Symptoms of Viral Conjunctivitis?

Common symptoms of pink eye include:

  • Redness in one or both eyes.
  • Itching in one or both eyes.
  • Stiffness in one or both eyes.
  • A discharge from the eye, which may crust overnight, is likely to obstruct eye-opening in the morning.
  • Excessive tearing.
  • Photophobia, or sensitivity to light.

How Contagious is Viral Conjunctivitis?

Viral conjunctivitis can be highly contagious, especially during the acute phase when symptoms are most pronounced. The virus responsible for conjunctivitis can be spread by direct contact with infected persons, contaminated surfaces, or shared objects such as towels or makeup. Proper hygiene, such as frequent hand washing and avoiding touching the eyes, can help reduce the risk of transmission. It is advised to avoid close contact with others, especially in settings where the virus can spread easily, such as schools or daycare centers, until symptoms subside and medical attention is sought if necessary. Treatment should not be attempted.

How Long Does Viral Conjunctivitis Last?

Viral conjunctivitis can persist for up to two weeks, with symptoms gradually improving over time. However, the duration may depend on various factors such as the specific virus causing the infection, the individual’s immune response, and any treatment being administered. Although there is no specific treatment for viral conjunctivitis, symptoms can be managed with supportive measures such as supportive eye drops and cold compresses to relieve discomfort. If symptoms persist or worsen, it is advisable to consult a healthcare professional for further evaluation and management.

The study of epidemiology

Whether caused by bacteria or viruses, conjunctivitis is a widespread condition that affects millions of Americans annually. Conjunctivitis accounts for about 1% of primary care visits in the United States. Albeit viral conjunctivitis is the most well-known structure, bacterial conjunctivitis is the second generally normal, making it hard for essential consideration doctors to separate between the two.

Antibiotics are often prescribed without sufficient justification, leading to unnecessary financial burdens on patients and contributing to the rise of drug-resistant bacteria. Additionally, employers and schools typically require individuals with conjunctivitis to stay home until the infection clears, further exacerbating the economic impact on those affected.

The pathophysiological understanding

Regardless of the cause, most cases of conjunctivitis can be classified as either papillary or follicular. Neither classification is specific to a particular disease. Papillary conjunctivitis is characterized by a cobblestone arrangement of flattened nodules with central vascular cores. It is most commonly associated with allergic reactions or responses to foreign bodies. Histologically, papillary conjunctivitis presents with closely packed, flat-topped projections, surrounded by numerous eosinophils, lymphocytes, plasma cells, and mast cells in the stroma around a central vascular channel.

Follicular conjunctivitis occurs under a variety of conditions, including inflammation caused by viruses, bacteria, toxins, and topical medications. Unlike papillae, follicles are small, dome-shaped nodules without central vessels. Histologically, these lymphoid follicles are located in the subepithelial region, which consists of a germinal center containing immature, proliferative lymphocytes surrounded by a ring of mature lymphocytes and plasma cells. In follicular conjunctivitis, the follicles are usually most prominent in the inferior palpebral and fornical conjunctivitis.

Physical and Historical Background

The diagnosis of viral conjunctivitis relies on clinical and laboratory signs. Early and accurate identification of the cause ensures appropriate treatment and helps prevent long-term complications.

Patients with viral conjunctivitis typically present with a sudden onset of foreign body sensation, red eyes, itching, light sensitivity, burning, and watery discharge. Patients with viral conjunctivitis often have a recent history of an upper respiratory tract infection or contact with an infected individual. Visual acuity usually remains near baseline, though the cornea may have subepithelial infiltrates that can reduce vision and cause light sensitivity. The conjunctiva appears red (injected) and may be swollen (edematous). Membranes or pseudomembranes, consisting of fibrin-rich exudates without blood or lymphatic vessels, may be present in the tarsal conjunctiva. True membranes can lead to subepithelial fibrosis, symblepharon, and significant bleeding upon removal.

Follicles

Follicles, small dome-shaped nodules without a central vessel, are often seen on the palpebral conjunctiva in viral conjunctivitis, but the presence of papillae does not exclude a viral cause. Palpating the preauricular lymph nodes may reveal a tender reactive lymph node, aiding in differentiating viral from bacterial conjunctivitis. Herpes simplex virus (HSV) can cause vesicles on the face or eyelids and affect vision, potentially involving the cornea. Herpes zoster virus presents with a linear dermatomal pattern of vesicles and typically red conjunctiva with mucopurulent discharge.

Fever, malaise, fatigue, and enlarged lymph nodes help distinguish viral conjunctivitis from other causes. Anisocoria and photophobia are associated with serious eye conditions such as anterior uveitis, keratitis, and scleritis. Systemic diseases that can be associated with conjunctivitis include skin and mucous membrane diseases (e.g., acne rosacea, ichthyosis, xeroderma pigmentosum), collagen vascular diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s disease, granulomatosis with polyangiitis), and autoimmune conditions (e.g., graft versus host disease, Steven-Johnson syndrome, and ocular cicatricial pemphigoid).

When to See a Doctor

Red eyes can indicate serious eye conditions with symptoms such as eye pain, foreign body sensation, blurred vision, and sensitivity to light. If you experience these symptoms, it is important to seek immediate medical attention.

For contact lens wearers, it is important to discontinue use at the onset of symptoms of pink eye. If symptoms persist or worsen within 12 to 24 hours, an appointment with an eye doctor is recommended to rule out any serious eye infection associated with contact lens use.

Close-up of an eye with red, watery conjunctiva, caused by viral conjunctivitis.

Treatment for Viral Conjunctivitis

Although viral conjunctivitis has no specific medicine to fight the virus itself, several methods can help control symptoms and make you feel more comfortable.

  • Artificial Tears: These lubricating eye drops are key. They help relieve irritation, reduce dryness and irritation, and reduce redness. If you’ll be using them frequently, look for preservative-free options.
  • Cool Compresses: Apply a cool washcloth soaked in clean water to your closed eyelids for 10-15 minutes at a time, a few times a day. Cooling helps reduce inflammation and redness.
  • Pain Relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage any discomfort you may be experiencing.

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Here are some additional tips for managing viral conjunctivitis

  • Avoid wearing contact lenses until your symptoms completely resolve.
  • Don’t use eye makeup When you have pink eye, and change any makeup you were using when symptoms start.
  • Get enough sleep To allow your body to fight the virus.

Important Note:

  • Avoid using antibiotic eye drops unless specifically prescribed by a doctor. Antibiotics will not work against viruses and may contribute to antibiotic resistance.
  • Corticosteroid eye drops may be prescribed in some severe cases, but consult a doctor before using them.

If your symptoms worsen or persist for more than two weeks, experience severe pain or vision problems, or are suspected of having a different type of conjunctivitis, seek appropriate diagnosis and treatment. Consult a doctor.

Faq’s 

Q1. How long does viral conjunctivitis last?

A1. Viral conjunctivitis can persist for up to 14 days. Unlike bacterial conjunctivitis, there is no specific treatment for viral conjunctivitis. A child can return to school or childcare when their tearing and discharge have significantly improved.

Q2. What is the fastest way to cure conjunctivitis?

A2. For bacterial conjunctivitis, the quickest treatment is to consult a doctor, who can prescribe antibiotic eye drops. According to a review by the Cochrane Database of Systematic Reviews, antibiotic eye drops can shorten the duration of bacterial pink eye.

Q3. How to stop conjunctivitis from spreading?

A3. To prevent the spread of conjunctivitis, avoid touching your eyes with unwashed hands. Do not share items used by an infected person, such as pillows, washcloths, towels, eye drops, makeup, makeup brushes, contact lenses, contact lens storage cases, or eyeglasses.

Q4. How to tell if conjunctivitis is viral or bacterial?

A4. Bacterial conjunctivitis typically causes a yellow or green sticky discharge throughout the day, with itchy eyes and possibly swollen eyelids. Viral conjunctivitis usually results in a watery discharge during the day and a sticky discharge in the morning, often with significantly swollen eyelids.

Q5. Will antibiotic drops help viral conjunctivitis?

A5. Antibiotic drops will not improve viral conjunctivitis, as antibiotics are ineffective against viruses.

Q6. How painful is viral conjunctivitis?

A6. Viral conjunctivitis can cause moderate redness and pain, often described as a sandy, gritty sensation in the eye. It may also cause moderate to severe light sensitivity.

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