Viral conjunctivitis: diagnosis, treatment and prevention

Introduction

Typical of flu states, viral conjunctivitis consists of an "inflammation of the conjunctiva caused by viruses. The most common pathogens are precisely: Adenovirus, Herpes simplex, Herpes zoster and molluscum contagiosum.

In the course of the article we will shed light on the most suitable diagnostic strategies to ascertain a suspicion of viral conjunctivitis and we will analyze which are the drugs of choice for the treatment of this ophthalmic infection.

Diagnosis

Viral conjunctivitis must be diagnosed and treated promptly, especially in young children more exposed to the risk of infections. Before undertaking any type of therapy, it is essential to ascertain the nature of the infection in order to eradicate the responsible pathogen as soon as possible.

In fact, it should not be forgotten that, in its early stages, viral conjunctivitis can easily be mistaken for another type of ophthalmic infection, since the symptoms - rather vague and non-specific - are common to most eye infections.
A presumed viral conjunctivitis must be diagnosed by the ophthalmologist through the analysis of the symptoms reported by the patient (anamnesis) and the direct observation of the eye performed with suitable optical instruments. The physical examination is essential to evaluate the severity of the condition, as well as the degree of ocular redness, the depth of the infection and the possible presence of bullous lesions and / or rashes in the margin of the eyelids.

Symptoms and complications of viral conjunctivitis

The typical symptoms of viral conjunctivitis to be sought during the medical check-up are: hyperlacrimation, photophobia (intolerance to light), eyelid edema, not particularly intense itching, red eyes.
Possible complications may instead include: conjunctival hemorrhage, formation of small blisters along the eyelid margin (typical lesions induced by herpes viruses), blurred vision, involvement of the cornea.

The diagnostic investigation also involves the taking of a conjunctival secretion sample: the subsequent cytological (cellular) investigation of the sample can in fact reveal the pathogen involved.
The differential diagnosis, very important for the purposes of therapy, must be placed with all ocular infections that can begin - or manifest themselves later - with symptoms the same or similar to those of the viral conjunctiva. It is therefore necessary to distinguish viral conjunctivitis from:

Acute hemorrhagic conjunctivitis
Allergic conjunctivitis
Bacterial conjunctivitis
Keratitis (inflammation of the cornea)
Dry / atopic keratoconjunctivitis (inflammation of the cornea and conjunctiva)
Adverse reactions to contact lenses
Uveitis
Trauma to the eye

Treatment

Mild forms (the most common) of viral conjunctivitis, especially those caused by Adenovirus, tend to regress on their own without the need for specific medications. In this case, the most appropriate therapy is the symptomatic one, that is a type of treatment aimed exclusively at improving the symptoms, without acting in any way on the cause of origin (infection).
Cold compresses on the eyes can reduce the swelling and eyelid heaviness that accompany viral conjunctivitis. Even ophthalmic ointments or lubricating and humectant eye drops can improve the patient's clinical picture. Eye discomfort and inflammation can be controlled or improved through the instillation of analgesic and anti-inflammatory eye drops: in these cases, the most suitable drugs are ibuprofen and ketorolac.
Vasoconstrictor and antihistamine eye drops are not the first choice therapy since viral conjunctivitis does not depend on an allergic reaction and ocular itching is quite bearable.
To reduce healing times, some doctors prescribe a topical treatment with ophthalmic ointments or antiviral eye drops: acyclovir, just to give an example, is an excellent active ingredient for the treatment of viral conjunctivitis.

Despite what has been stated, we remind you once again that antiviral drugs are not always indispensable for healing because very often viral conjunctivitis regresses spontaneously.

Corticosteroid drugs, powerful anti-inflammatory drugs, are strongly discouraged in the presence of mild viral conjunctivitis: an inadequate or excessive administration of these drugs can in fact create unpleasant complications to the internal ocular structures.
Therapy with topical corticosteroids, on the other hand, is essential in those affected by viral conjunctivitis associated with keratitis with extension into the corneal stroma.
Relapsing forms of herpes virus keratitis can be prevented by long-term oral antiviral drugs. Similarly, herpes zoster-borne viral conjunctivitis requires systemic antiviral treatment with active ingredients such as idoxuridine, vidarabine, valaciclovir or famciclovir , to be undertaken as soon as possible (starting from the onset of symptoms).
Bullous lesions and vesicles induced by a 'contagious molluscum conjunctival infection can be removed by cauterization, cryotherapy, or surgical excision.

Prevention

Preventing viral conjunctivitis is quite simple: it is necessary to scrupulously observe the common hygiene rules to reduce the risk of viral infections in general.
Since viral conjunctivitis is a highly contagious infection, affected patients should first of all avoid the mixed use of toiletries (such as towels and washcloths), pillows, sheets or handkerchiefs to avoid spreading the infection.
Another extremely useful precaution to prevent viral conjunctivitis and eye infections in general is hand washing, which must be carried out with particular attention and several times during the day. Clearly, washing hands is a must before touching the eyes. .
The use of shielding sunglasses of excellent quality is also useful to protect the eyes from dust and UV rays.
In case of antibiotic therapy prescribed to cure a certain infection, it is recommended to take yogurt with live lactic ferments or a probiotic to strengthen the immune defenses, clearly weakened by drugs.
A very important precaution, which unfortunately we tend to underestimate, is to throw the make-up cosmetics used in the first stages of a viral conjunctivitis into the garbage. The above is essential to avoid infecting the eye again after having eradicated the virus.
The same goes for the ampoules of multidose eye drops: to minimize the risk of self-contamination (and to avoid traumatizing the eye), the nozzle of the eye drops must not come into contact with any structure of the eye.

In conclusion, it is good practice to keep children with viral conjunctivitis home from school: although the symptoms may subside in 3-4 days, the infection is contagious for 7-10 days.

Prevention is synonymous with the protection of one's own health and respect for others: the observation of these simple hygiene-behavioral rules is essential to limit the spread of viral conjunctivitis as much as possible.