Can hand, foot, and mouth disease (HFMD) cause burning eyes?

Hand, Foot, and Mouth Disease and Ocular Symptoms

Hand, foot, and mouth disease (HFMD) can cause conjunctivitis with burning eye sensation, although this is not among its most common manifestations. Based on current clinical guidelines, ocular involvement in HFMD typically presents as conjunctivitis, which may include symptoms of burning or irritation.

Clinical Presentation of HFMD

HFMD is a highly contagious viral infection primarily caused by enteroviruses, most commonly:

• Coxsackievirus A16 (CV-A16) - traditionally most common
• Enterovirus A71 (EV-A71) - associated with more severe cases
• Coxsackievirus A6 (CV-A6) - increasingly common in recent outbreaks
• Coxsackievirus A10 (CV-A10) - emerging pathogen 1

Typical Symptoms

• Fever
• Malaise and myalgia
• Characteristic maculopapular or vesicular eruptions on:
  • Hands
  • Feet
  • Oral cavity 2, 3

Ocular Involvement in HFMD

While not listed among the primary symptoms, evidence suggests that HFMD can affect the eyes:

1. The Journal of Clinical Virology specifically recommends eye swabs as the appropriate sample type for diagnosis when conjunctivitis is present in HFMD cases 4

2. Conjunctivitis can present with:

   • Burning sensation
   • Redness (conjunctival injection)
   • Tearing
   • Discharge
   • Irritation 4

Diagnostic Considerations

When HFMD is suspected with ocular symptoms:

• Appropriate samples for testing include:

  • Vesicle fluid
  • Respiratory samples
  • Stool samples
  • Eye swabs (when conjunctivitis is present) 4, 1

• Diagnostic methods:

  • Reverse transcriptase PCR (RT-PCR) targeting the 5′non-coding regions for initial diagnosis
  • VP1 capsid protein gene sequencing for enterovirus typing 1

Clinical Course and Complications

• Most HFMD cases are self-limiting with complete recovery within a week
• Ocular involvement typically resolves without specific treatment
• However, severe complications can occur, including:
  • Neurological complications (encephalitis, meningitis)
  • Pulmonary edema
  • Myocarditis 2, 5

Key Points for Clinicians

• Burning eyes in a patient with other HFMD symptoms should prompt consideration of conjunctivitis as part of the disease presentation
• Conjunctivitis in HFMD is typically self-limiting but should be monitored
• If eye symptoms are severe or persistent, consider other potential causes of conjunctivitis
• Viral conjunctivitis can be highly contagious, so appropriate precautions should be taken 4

Differential Diagnosis for Eye Symptoms

When evaluating burning eyes in a patient with suspected HFMD, consider other causes:

• Allergic conjunctivitis
• Bacterial conjunctivitis
• Medication-induced/preservative-induced keratoconjunctivitis
• Dry eye syndrome 4

Remember that HFMD primarily affects children under 5 years of age, but can also affect immunocompetent adults, particularly through familial transmission 2, 3.