Viral conjunctivitis in children

ICD-10 code

• B30.0 Keratoconjunctivitis caused by adenovirus (H19.2).
• B30.1 Conjunctivitis caused by adenovirus (H13.1).
• B30.2 Viral pharyngoconjunctivitis.
• B30.3 Acute epidemic hemorrhagic conjunctivitis (enterovirus; H13.1).
• В30.8 Other viral conjunctivitis (H13.1).
• B30.9 Viral conjunctivitis, unspecified.
• H16 Keratitis.
• H16.0 Corneal ulcer.
• H16.1 Other superficial keratitis without conjunctivitis.
• H16.2 Keratoconjunctivitis (epidemic B30.0 + H19.2).
• H16.3 Interstitial (stromal) and deep keratitis.
• H16.4 Neovascularization of the cornea.
• H16.9 Unspecified keratitis.
• H19.1 Keratitis due to herpes simplex virus, and keratoconjunctivitis (B00.5).

Adenoviruses cause two clinical forms of eye disease: adenoviral conjunctivitis (pharyngoconjunctival fever) and epidemic keratoconjunctivitis (occurs more severely and is accompanied by corneal involvement). In children, more often there is pharyngoconjunctival fever, less often epidemic keratoconjunctivitis. Viral conjunctivitis almost always accompanies the general reaction of the body in the form of damage to the upper respiratory tract, increased body temperature, sleep disturbances and the appearance of dyspepsia, tenderness and enlargement of the lymph nodes.

Adenoviral conjunctivitis (pharyngoconjunctival fever)

The disease is highly contagious, transmitted by airborne droplets and by contact routes. Mostly children of preschool and primary school age are sick in groups.

Eye damage is preceded by a clinical picture of acute catarrh of the upper respiratory tract with pharyngitis, rhinitis, tracheitis, bronchitis, otitis, dyspepsia, fever up to 38-39 ° C.

The incubation period is 3-10 days. The defeat is usually bilateral: first one eye, and after 1-3 days - the second. Characteristics of photophobia, lacrimation, edema and hyperemia of the skin of the eyelids, mild hyperemia and conjunctival infiltration, poor serous-mucous discharge, small follicles, especially in the area of transitional folds, sometimes - pinpoint hemorrhages. Less often, there are point subepithelial infiltrates of the cornea, disappearing without a trace. Children can form delicate grayish-white films, when removed, exposing the bleeding surface of the conjunctiva. Papillary reaction is rarely noted. Half of the children have regional painful pre-adenopathy. All clinical symptoms last no more than 10-14 days.

[1], [2], [3], [4]

Epidemic keratoconjunctivitis

The disease is characterized by high contagiosity. Infection spreads contact, less often - airborne droplets. Often, infection occurs in medical institutions. The duration of the incubation period is 4-8 days.

The onset is acute with defeat of both eyes. Against the background of moderate respiratory manifestations, almost all patients notice an increase and soreness of the parotid lymph nodes. Clinical manifestations are similar to adenoviral conjunctivitis, but more pronounced. The course is more severe: films on the conjunctiva, hemorrhages are often formed. On the 5th-9th day from the onset of the disease, point subepithelial (coin-like) infiltrates appear on the cornea, leading to a decrease in vision. In their place, stable corneal opacities are formed. The duration of the infectious period is 14 days, the disease is 1-2 months, after recovery, immunity remains.

[5], [6], [7], [8],

Epidemic hemorrhagic conjunctivitis

Children are less common than adults. The causative agent is enterovirus-70. The disease is transmitted by contact; it is distinguished by an extremely high contagiosity. "Explosive type" of the epidemic, a short incubation period (12-48 hours).

On examination: eyelid edema, chemosis and infiltration of the conjunctiva, individual small follicles on the lower transitional fold, mild mucous or mucopurulent discharge. Typical hemorrhages in the conjunctival tissue and under it, arising during the first hours of the disease and disappearing after a few days. The sensitivity of the cornea is reduced, sometimes there are point subepithelial infiltrates that quickly and completely disappear after a few days. Characterized by the increase and soreness of the anterior ear lymph nodes. Duration of the disease - 8-12 days, ends with recovery.

[9], [10], [11]

Treatment of viral conjunctivitis in children

Treatment of adenoviral conjunctivitis

• Interferons (ophthalmoferon, etc.) in installations from 6-10 times a day in an acute period up to 2-3 times a day as the severity of inflammation subsides.
• Antiseptic and antibacterial agents for the prevention of secondary infection (pikloksidin, fusidic acid, erythromycin ointment).
• Anti-inflammatory (diclofenac), antiallergic (ketotifen, cromoglycic acid) and other drugs.
• Tear-substituting agents (hypromellose + dextran or sodium hyaluronate) 2-4 times a day (with a tear fluid deficiency).

Treatment of epidemic keratoconjunctivitis and epidemic hemorrhagic conjunctivitis

To local treatment, similar treatment of adenoviral conjunctivitis. At corneal rashes or formation of films it is necessary to add:

• glucocorticoids (dexamethasone) 2 times a day;
• preparations stimulating the regeneration of the cornea (taurine, vitasik, dexpanthenol), 2 times a day;
• tear-replacing drugs (hypromellose + dextran, sodium hyaluronate).