Epidemic hemorrhagic conjunctivitis

Epidemic hemorrhagic conjunctivitis, or acute hemorrhagic conjunctivitis, has been described relatively recently. The first pandemic of epidemic hemorrhagic conjunctivitis began in 1969 in West Africa and then spread to countries in North Africa, the Middle East, and Asia. Epidemic outbreaks occurred worldwide in 1981-1984 and 1991-1992. Outbreaks of epidemic hemorrhagic conjunctivitis recur worldwide with a certain periodicity. Epidemic hemorrhagic conjunctivitis is caused by picornaviruses (enterovirus-70, Coxsackie, ECHO, etc.). It affects up to 30-40% of the population.

The causative agent of epidemic hemorrhagic conjunctivitis is enterovirus-70. Epidemic hemorrhagic conjunctivitis is characterized by a short incubation period, unusual for a viral disease - 52-48 hours. The main route of infection is contact. Epidemic hemorrhagic conjunctivitis is highly contagious, the epidemic proceeds in an explosive manner. In the absence of anti-epidemic measures, 80-90% of patients in ophthalmological hospitals may be affected.

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Symptoms of epidemic hemorrhagic conjunctivitis

Epidemic hemorrhagic conjunctivitis usually begins acutely, first one eye is affected, after 8-24 hours - the second. Due to severe pain and photophobia, the patient seeks help on the first day. The conjunctiva is sharply hyperemic, chemosis, follicular conjunctivitis are noted. Small and large subconjunctival hemorrhages appear on the conjunctiva of the eyelids and the eyeball. The discharge from the conjunctiva is mucous or mucopurulent. Extensive hemorrhages can capture almost the entire conjunctiva of the sclera. Changes in the cornea are insignificant - point epithelial infiltrates that disappear without a trace. Enlarged preauricular lymph nodes are palpated.

The clinical manifestations of conjunctivitis are very specific. First of all, it is an acute onset. Incubation takes 1-2 days (sometimes 8-12 hours). The first symptom of conjunctivitis is a burning sensation in the eyes, inability to look at the light. In this condition, the patient consults a doctor. During examination, swelling of the eyelids, chemosis of the conjunctiva, its infiltration, individual follicles on the lower transitional fold are noted. The discharge is usually not very abundant, mucous or mucopurulent in nature. Typical hemorrhages in the conjunctival tissue and under the conjunctiva, appearing in the first hours of the disease and disappearing after a few days, and in some cases after 2 weeks. They have different sizes and different shapes. Sometimes this is a continuous hemorrhage located over the entire area of the conjunctiva of the sclera, sometimes a hemorrhage in the form of a smear. In some cases, microhemorrhages in the form of petechiae are observed. It is impossible to see them with the naked eye. When examining such patients, it is necessary to use the biomicroscopy method. Barely noticeable hemorrhages should be looked for in the upper half of the conjunctiva of the sclera, where they are most often concentrated.

The second clinical sign, pathognomonic for this conjunctivitis, is the appearance of small, point-shaped spots of white or white-yellow color in the conjunctiva. They resemble infarctions of the meibomian glands, which are well known to ophthalmologists. This symptom does not occur in other clinical forms of viral conjunctivitis. It owes its origin to the cytopathic action of the virus that causes hemorrhagic conjunctivitis. Penetrating into the excretory ducts of the mucous and accessory lacrimal glands of the conjunctiva, the virus causes their blockage with necrotic cells lining the duct. The clinical picture of conjunctivitis is generally supplemented by adenopathy of the preauricular lymphatic glands, expressed in their soreness and obvious enlargement. In some cases, keratitis develops. Its peculiarity lies in the superficial epithelial localization of the process. Small infiltrates usually appear on the cornea, stained with a 2% fluorescein solution. After a few days, the keratitis symptoms disappear almost without a trace. As for the symptoms of conjunctivitis, they last an average of 10 days, sometimes up to 2 weeks. Trace reactions can remain for some time, which leads to complaints of discomfort at work, a sensation of a foreign body in the eye. The clinical picture of conjunctivitis can be combined with general symptoms in the form of weakness, malaise, and fever. In such cases, the diagnosis of influenza or catarrh of the upper respiratory tract is erroneously made, against which the therapist may not take into account or falsely interpret the eye symptoms. Differential diagnostics of epidemic hemorrhagic conjunctivitis should also be carried out with such conditions that seem to have no relation to this disease, such as professional conjunctivitis, electric ophthalmia, snow ophthalmia. They are related to hemorrhagic conjunctivitis by the commonality of subjective sensations in the form of acute pain, photophobia, lacrimation, with which a person exposed to iodine vapors at work or ultraviolet radiation may come to the appointment. A thorough examination, carried out after instillation of a 0.5% dicaine solution into the conjunctival cavity, allows one to diagnose hemorrhagic conjunctivitis based on the pathognomonic symptoms described above.

Treatment of epidemic hemorrhagic conjunctivitis

Antiviral eye drops (interferon, interferon inducers) are used in combination with anti-inflammatory drugs (initially antiallergic, and from the second week - corticosteroids in low concentrations - 0.001% dexamethasone solution). The duration of treatment is about 9-14 days. Recovery usually occurs without consequences.