Viral Conjunctivitis

by Carlo Raj, MD

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    00:01 And we have the second type of conjunctivitis but this would be viral.

    00:04 The first type was bacterial which was the most common was staph aureus.

    00:07 With viral, the most common will be adenovirus causing conjunctivitis.

    00:12 Take a look at the eye here, please.

    00:14 We're not having issues with the cornea.

    00:16 The cornea is the window.

    00:18 No, no, no. That's not the problem.

    00:20 You see the injected conjunctiva? You see the blood vessels and such that are now undergoing a little bit of dilation because of irritation? And you notice here that the tearing that's taken place'what tearing? Exactly, what I'm saying is it's not white.

    00:35 Bacterial conjunctivitis, they will give you a picture in which it is pus.

    00:42 That's bacterial conjunctivitis. This is viral.

    00:45 So it would be watery type of tearing that you can expect.

    00:48 But in allergic conjunctivitis, right? For example, you've been expose to, let's say antigens which then triggered a type of hypersensitivity.

    00:57 That's your allergic type of conjunctivitis.

    01:00 There also would be watery but completely different discussion, where there, there's going to be quite a bit of itching and such.

    01:06 Viral, the most common will be adenovirus.

    01:09 Now, what may then happen? Unfortunately, is that it may result in something called keratoconjunctivitis.

    01:16 And with keratoconjunctivitis, the strains here for adenovirus include 8,19, and 37 being the most common.

    01:23 So we have conjunctivitis but adenovirus certain strains 8,19, and 37 may result in worsening pathology which we then call keratoconjunctivitis.

    01:34 In addition, there is a viral infection so therefore you're gonna have lymphadenopathy, perhaps, by what's known as your preauricular region.

    01:45 Right here.

    01:46 And this lymph node here may then undergo adenopathy.

    01:50 Viral.

    01:51 Compare that here to allergic.

    01:53 Here once again the eyes there is reddening, but if you take a look at your tears it is not white.

    01:59 It's not pus. It's watery discharge.

    02:02 You're going to be looking for history of a patient whose been exposed to what? Allergens.

    02:07 So maybe there's itching, coughing and such, maybe sneezing, right? What you can expect with allergy? Maybe issues with the bronchi.

    02:16 So there's intense itching and burning, watery discharge, and it's not contagious.

    02:22 This is a type I hypersensitivity. It's allergic.

    02:25 But now we're leaving behind our conjunctivitis.

    02:28 There are three major ones we just discussed, and they were bacterial, viral, and allergic.

    02:33 Prior to that, we talked about a conjunctivitis that you find in newborn.

    02:36 And what was the name of that, please? Good. Ophthalmia neonatorum.

    02:40 There are two major bacteria there that you wanna keep in mind, and they were Neisseria gonorrhea and the other one is chlamydia.

    02:47 Make sure you know how to manage those. Let's continue.

    02:50 Here the patient, take a look at this eye and you notice, My, goodness! I can barely even see anything.

    03:00 Correct. Is that a cataract? This is keratomalacia secondary to Vitamin A deficiency.

    03:07 Remember, Vitamin A is responsible for proper maturing of a cell.

    03:12 So what may then happen is that when there is a Vitamin A deficiency? May result in severe keratinization of the entire mucus membrane of the eye.

    03:22 And when that happens, it's gonna cause this incredible, incredible destruction of the conjunctiva, maybe perhaps even the cornea as well, called keratomalacia, malacia, referring to Vitamin A deficiency.

    03:37 Now, may I ask you something else.

    03:38 If this was a different part of the eye, or could the Vitamin A deficiency result in damage to a different part of the eye? Yes. What part am I referring to? The retina, and in the retina specifically, what layers could then be affected? Good. The photoreceptors, right? And hence maybe there's issues with the cones, maybe the rods.

    04:03 In other words there might be night blindness, correct, with Vitamin A deficiency.

    04:07 So you have keratomalacia and then in the retina you'll have night blindness.

    04:12 Keep that in mind for Vitamin A deficiency. A fat soluble vitamin.

    04:16 Trachomas, here we are.

    04:19 Trachoma could and is one of the leading cause of blindness in the world.

    04:24 But this is not the D through K or the L1 through L3 strains, because those would then cause genital issues or sexually transmitted infection.

    04:35 The strains here that you'll be focusing upon will be A, B and C.

    04:39 So here are causes of conjunctivitis.

    04:42 Corneal epithelial mep can then be affected.

    04:44 And therefore may result in the opacity of the cornea.

    04:48 Once again this is not a cataract, this is secondary to trachoma.

    04:51 Chlamydia trachomatis A, B, and C.

    04:53 If left untreated, the patient is then going into blindness.

    04:58 An issue here in which removing from the conjunctiva, take a look at the picture here, I'm gonna tell you a little story here.

    05:08 So on the far right you'll see that the conjunctiva and it's moving towards the cornea, and you see as to how there's almost like a triangular point like lesion and growth into the cornea? You see that? Are we good? That is called pterygium or pterygium.

    05:32 Pterygium is a benign superficial growth that usual then begin in the perilimbal conjunctiva, as you see here on the far right, and what it will do, it kinda like, well, you know what a pterodactyl is? It's a dinosaur that had wings? Anyhow, a wing of a bird or in this case, a dinosaur is pointed at the end.

    05:57 It looks like the wing of the conjunctiva is extending into the cornea.

    06:03 You see that pointed region there? That's your typical, typical presentation of pterygium.

    06:08 Vary in size from person to person, and this is benign though.

    06:14 It's not a cancer, it's not gonna obviously result in blindness, but major irritation, opacity maybe a little bit of blurring, and look for history of where this patient has been exposed to UV rays.

    06:26 Maybe a surfer out on you know a daily basis exposed to or with the UV rays coming in, or a skier.

    06:35 So maybe on the Alps, Rockies, what have you.

    06:38 And not having proper protection of the eyes, oftentimes you'll find pterygium.

    06:44 So here the pathogenesis and risk factors where pterygium include, increased exposure of the eyes to the UV rays, so therefore, your next step of management, protection of the eyes.

    About the Lecture

    The lecture Viral Conjunctivitis by Carlo Raj, MD is from the course Optic Pathology. It contains the following chapters:

    • Viral vs. Allergic Conjunctivitis
    • Conjunctival Disorders

    Included Quiz Questions

    1. Adenovirus
    2. Herpes simplex virus
    3. Varicella zoster virus
    4. Enterovirus 70
    5. Coxsackie A24
    1. Preauricular lymphadenopathy
    2. Submental lymphadenopathy
    3. Submandibular lymphadenopathy
    4. Posterior cervical lymphadenopathy
    5. Postauricular lymphadenopathy
    1. A, B, C
    2. D, E, F
    3. G, H, I
    4. J, K
    5. L1, L2, L3
    1. Vitamin A
    2. Vitamin C
    3. Vitamin D
    4. Vitamin E
    5. Vitamin K

    Author of lecture Viral Conjunctivitis

     Carlo Raj, MD

    Carlo Raj, MD

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