clinical features

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  • onset of presentation may be slightly slower than occurs with bacterial conjunctivitis
  • there is profuse watery discharge
  • the eye may be sticky; however it is not, in general, frankly purulent
  • the conjunctiva may be injected and chemotic (swollen)
  • the eyelids may be swollen
  • often, there is a superficial punctate keratitis but the corneal lesions may be difficult to see with the naked eye
  • involvement of tarsal follicles and a pre-auricular lymphadenopathy are common. There may be a sore throat and fever
  • it is common for there to be some mild photophobia
  • in general, viral conjunctivitis is bilateral although often asymmetric in severity and presentation
  • herpes simplex virus may cause a unilateral conjunctivits as part of the primary attack; however it is less common with secondary involvement. In the primary attack a vesicular eruption may occur around the eye. Conjunctivitis may occur with herpes zoster and there is generally the typical rash in the ophthalmic division of the trigeminal nerve. In both herpes simplex and herpes zoster conjunctivitis, the cornea should be inspected for involvement and the patient referred immediately to a specialist centre
  • in adeno viral infections cornea is commonly affected; known as keratoconjunctivitis characterized by inflammation of the corneal epithelium
    • may appear in stages
      • diffuse epithelial keratitis appearing within seven days of onset, and resolving within 2 weeks
      • transient focal epithelial keratitis appearing one week after onset
      • subepithelial infiltrates
  • Enterovirus 70 and Coxsackie A24 cause a mild transient epithelial keratitis (2)


  1. Prescribers' Journal 2000; 40 (2): 130-137.
  2. Kanski, Clinical Ophthalmology: A Systematic Approach: 4rdEd, 1999,chapter 3, p63-65, Butterworth-Heinman.

Last reviewed 01/2018