Viral conjunctivitis in children

ICD-10 code

• B30.0 Keratoconjunctivitis due to adenovirus (H19.2).
• B30.1 Conjunctivitis due to adenovirus (H13.1).
• B30.2 Viral pharyngoconjunctivitis.
• B30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral; H13.1).
• B30.8 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 Corneal neovascularization.
• H16.9 Keratitis, unspecified.
• H19.1 Herpes simplex keratitis and keratoconjunctivitis (B00.5).

Adenoviruses cause two clinical forms of eye disease: adenoviral conjunctivitis (pharyngoconjunctival fever) and epidemic keratoconjunctivitis (more severe and accompanied by corneal damage). In children, pharyngoconjunctival fever occurs more often, and epidemic keratoconjunctivitis occurs less often. Viral conjunctivitis is almost always accompanied by a 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, pain, and enlargement of the lymph nodes.

Adenoviral conjunctivitis (pharyngoconjunctival fever)

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

Eye damage is preceded by a clinical picture of acute catarrh of the upper respiratory tract with symptoms of pharyngitis, rhinitis, tracheitis, bronchitis, otitis, dyspepsia, and an increase in body temperature to 38-39 °C.

The incubation period is 3-10 days. The lesion is usually bilateral: first one eye, and after 1-3 days - the other. Characteristic are photophobia, lacrimation, edema and hyperemia of the skin of the eyelids, moderate hyperemia and infiltration of the conjunctiva, scanty serous-mucous discharge, small follicles, especially in the area of transitional folds, sometimes - pinpoint hemorrhages. Less often, pinpoint subepithelial infiltrates of the cornea are formed, disappearing without a trace. In children, delicate grayish-white films may form, which, when removed, expose the bleeding surface of the conjunctiva. Papillary reaction is rarely noted. In half of the children, regional painful preauricular adenopathy is found. All clinical symptoms last no more than 10-14 days.

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Epidemic keratoconjunctivitis

The disease is highly contagious. The infection spreads by contact, less often by airborne droplets. Often, infection occurs in medical institutions. The incubation period lasts 4-8 days.

The onset is acute with damage to both eyes. Against the background of moderate respiratory manifestations, almost all patients experience enlargement 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 and hemorrhages often form. On the 5th-9th day from the onset of the disease, punctate subepithelial (coin-shaped) infiltrates appear on the cornea, leading to decreased vision. In their place, persistent corneal opacities form. The duration of the infectious period is 14 days, the disease is 1-2 months, immunity remains after recovery.

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Epidemic hemorrhagic conjunctivitis

It is less common in children than in adults. The causative agent is enterovirus-70. The disease is transmitted by contact; it is characterized by extremely high contagiousness. "explosive type" of epidemic, short incubation period (12-48 hours).

On examination: eyelid edema, chemosis and conjunctival infiltration, individual small follicles on the lower transitional fold, moderate mucous or mucopurulent discharge. Typical hemorrhages into and under the conjunctival tissue, occurring in the first hours of the disease and disappearing after a few days. Corneal sensitivity is reduced, sometimes point subepithelial infiltrates occur, quickly and without a trace disappearing after a few days. Characteristic are enlargement and soreness of the anterior auricular lymph nodes. Duration of the disease is 8-12 days, ending with recovery.

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Treatment of viral conjunctivitis in children

Treatment of adenoviral conjunctivitis

• Interferons (oftalmoferon, etc.) in instillations from 6-10 times a day in the acute period to 2-3 times a day as the severity of the inflammation subsides.
• Antiseptic and antibacterial agents for the prevention of secondary infection (picloxidine, fusidic acid, erythromycin ointment).
• Anti-inflammatory (diclofenac), anti-allergic (ketotifen, cromoglycic acid) and other drugs.
• Tear substitutes (hypromellose + dextran or sodium hyaluronate) 2-4 times a day (if there is insufficient tear fluid).

Treatment of epidemic keratoconjunctivitis and epidemic hemorrhagic conjunctivitis

To local treatment, similar to the treatment of adenoviral conjunctivitis, in case of corneal rashes or film formation it is necessary to add:

• glucocorticoids (dexamethasone) 2 times a day;
• drugs that stimulate corneal regeneration (taurine, vitasik, dexpanthenol), 2 times a day;
• tear substitutes (hypromellose + dextran, sodium hyaluronate).