What are the symptoms and treatment options for viral herpes conjunctivitis?

Symptoms of Viral Herpes Conjunctivitis

Herpes simplex viral conjunctivitis typically presents with unilateral bulbar conjunctival injection, watery discharge, and mild follicular reaction of the conjunctiva, often accompanied by a palpable preauricular lymph node. 1

Clinical Presentation

Primary Signs and Symptoms

• Usually unilateral, though can be bilateral especially in atopic, pediatric, or immunocompromised patients 1
• Bulbar conjunctival injection (redness) 1
• Watery discharge 1
• Mild follicular reaction of the conjunctiva 1
• Palpable preauricular lymphadenopathy 1

Distinctive Signs

• Vesicular rash or ulceration of the eyelids 1
• Pleomorphic or excavated dendritic epithelial keratitis of the cornea 1
• Ulceration of the conjunctiva 1
• Punctate epithelial keratitis that may evolve to dendritic ulcers in 15% of cases 2

Associated Symptoms

• Redness, watering, discharge 2
• Itching, irritation, lid swelling 2
• Less frequently: pain, photophobia, blurred vision 2
• Systemic symptoms in 31% of patients: mild malaise, fever, aching 2
• Upper respiratory tract infection in 35% of patients 2

Disease Course and Natural History

• Usually self-limited, subsiding without treatment within 4-7 days unless complications occur 1
• Severity varies from mild to severe 3
• In primary infections, symptoms may be more pronounced with systemic involvement 2
• Chronic blepharoconjunctivitis may develop in approximately 15% of patients 2

Potential Complications

• Blepharitis 1
• Epithelial keratitis 1
• Corneal edema 1
• Endotheliitis 1
• Stromal keratitis 1
• Neovascularization 1
• Corneal scarring, thinning, perforation 1
• Uveitis, trabeculitis, retinitis 1

Predisposing Factors

• Prior infection with HSV 1
• Triggers for reactivation include:
  • Stress 1
  • Acute viral or febrile illnesses 1
  • Ultraviolet exposure 1
  • Surgery or trauma 1
• Primary HSV infection: exposure to an infected individual 1

Diagnostic Considerations

• Must be differentiated from other viral conjunctivitis (especially adenoviral) 3, 4
• Presence of vesicular lid lesions and dendritic corneal lesions are highly suggestive of herpes simplex 1
• Absence of itching helps differentiate from allergic conjunctivitis 4
• Watery rather than purulent discharge helps differentiate from bacterial conjunctivitis 4

Treatment Approach

• Antiviral medications are indicated for herpes simplex viral conjunctivitis, unlike most other viral conjunctivitis types 5, 4
• Commonly used antivirals include aciclovir, trifluridine, and valaciclovir 5
• Ganciclovir ophthalmic gel has shown similar efficacy to acyclovir ointment for dendritic ulcers 6
• Caution with corticosteroid use as it may worsen herpes infection 5, 7
• Supportive care with warm compresses and artificial tears may help relieve symptoms 7

Prevention of Transmission

• Avoid touching eyes 7
• Frequent handwashing 3, 7
• Use disposable towels 7
• Avoid group activities while discharge is present 7
• Sanitize surfaces 3