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 swept the countries of North Africa, the Middle East and Asia. Epidemic outbreaks in the world arose in 1981-1984 and 1991-1992. Outbreaks of epidemic hemorrhagic conjunctivitis in the world are repeated with a certain periodicity. Epidemic hemorrhagic conjunctivitis is caused by picornaviruses (enterovirus-70, Coxsackie, ESNO, 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 virus disease - 52-48 hours. The main way of spreading infection is a contact one. High contagiosity of epidemic hemorrhagic conjunctivitis is noted, the epidemic follows an explosive type. In the absence of anti-epidemic measures, 80-90% of patients in the eye hospitals can be affected.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Symptoms of epidemic hemorrhagic conjunctivitis

Epidemic hemorrhagic conjunctivitis usually begins acutely, first one eye is affected, after 8-24 hours - the second. Because of severe pain and photophobia, the patient looks for 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. Detachable from the conjunctiva mucous or mucopurulent. Extensive hemorrhages can seize almost the entire conjunctiva of the sclera. The corneal changes are insignificant - point epithelial infiltrates that disappear without a trace. Palpated enlarged premature lymph nodes.

Clinical manifestations of conjunctivitis are very peculiar. This is primarily an acute beginning. Incubation takes 1-2 days (sometimes 8-12 hours). The first symptom of conjunctivitis is the feeling of rubbing in the eyes, the inability to look at the light. In this condition, the patient consults a doctor. On examination, there are edema of the eyelids, chemosis of the conjunctiva, its infiltration, individual follicles on the lower transitional fold. Detachable is usually not very abundant, mucous or muco-purulent. Typical hemorrhages in conjunctival tissue and 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 shapes. Sometimes this is a continuous hemorrhage, located throughout the area of the conjunctiva of the sclera, sometimes a hemorrhage in the form of a smear. In some cases, microcirculation is observed in the form of petechiae. It is impossible to see them with the naked eye. When examining such patients, the biomicroscopy method should be used. A barely noticeable hemorrhage should be sought in the upper half of the scleral conjunctiva, where they are more often concentrated.

The second clinical sign, pathognomonic for this conjunctivitis, is the appearance in the conjunctiva of small, spotted spots of white or white-yellow color. They resemble familiar to ophthalmologists, myibomian infarctions. 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. Introduced with the excretory ducts of the mucous membranes and additional lacrimal glands of the conjunctiva, the virus causes their blockage by necrotic cells lining the duct. The clinical picture of conjunctivitis is generally supplemented by adenopathy of the pre-limphatic glands, expressed in their soreness and apparent increase. In some cases, keratitis develops. Its peculiarity lies in the superficial epithelial localization of the process. On the cornea usually appear small infiltrates, staining with 2% fluorescein solution. After a few days, the phenomena of keratitis almost completely disappear. As for the symptoms of conjunctivitis, they keep on average 10 days, sometimes up to 2 weeks. Trace reactions can remain for some time, which leads to complaints about discomfort during work, the sensation of a foreign body in the eye. The clinical picture of conjunctivitis can be combined with common phenomena in the form of weakness, malaise, fever. In such cases, the diagnosis is made of influenza or catarrh of the upper respiratory tract, against which the therapist may not be taken into account or the ocular symptomatology is misinterpreted. Differential diagnosis of epidemic hemorrhagic conjunctivitis should also be carried out with such seemingly unrelated conditions as professional conjunctivitis, electrical ophthalmia, and snow ophthalmia. They are related to hemorrhagic conjunctivitis by the generality of subjective sensations in the form of acutely arose pain, photophobia, lacrimation, with which a person who has been exposed to iodine vapors in the workplace or ultraviolet irradiation can appear on the device. Thorough examination, performed after instilling a 0.5% solution of dicaine into the conjunctival cavity, allows to diagnose hemorrhagic conjunctivitis based on the pathognomonic symptoms described above.

Treatment of epidemic hemorrhagic conjunctivitis

Antiviral eye drops (interferon, interferon inducers) in combination with anti-inflammatory drugs (antiallergic first, and from the second week - corticosteroids in low concentrations - 0,001% solution of dexamethasone) are used. The duration of treatment is about 9-14 days. Recovery usually occurs without consequences.