This guideline last updated 06/05/2022 17:48:15

Differential diagnosis

• Epidemic keratoconjunctivitis (e.g. adenovirus)
• Herpes simplex or Herpes zoster
• Chlamydial infection
• Allergy
• Angle closure glaucoma
• Infective keratitis
• Anterior uveitis

Possible management by Optometrist

• Wash hands carefully before and after examination and clean equipment before next patient
• Do not applanate with a re-usable tonometer prism as condition is highly contagious

Treatment

• Antibacterial and antiviral agents ineffective
• Artificial tears and lubricating ointments (drops for use during the day, unmedicated ointment for use at bedtime) may relieve symptoms
• Topical antihistamines may be used for severe itching

Advice

• Normally self-limiting, resolving within one to two weeks
• Highly contagious for family, friends and work colleagues (do not share towels)
  • Infection with adenovirus does not require time off work or school unless patient feels particularly unwell, or if working in close contact with others, or sharing equipment (in which case stay off work until discharge has cleared)
• Cold compresses may give symptomatic relief
• Discontinue contact lens wear in acute phase
• Ask patient to return if symptoms do not resolve or symptoms worsen

Management Category

• Normally no referral
• Emergency referral (same day)
• Visual loss
• Severe pain
• Significant keratitis
• Pseudomembrane

Possible management by Ophthalmologist

• None
• Conjunctival swabs for virus isolation and strain identification
• Topical low dose steroids may be prescribed where sub-epithelial opacities affect vision
• Topical steroid may also be indicated for conjunctival pseudomembrane formation