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.