Can crust formation on the eyelids or lashes occur with adenoviral conjunctivitis?

Can Crustiness of Eyes Accompany Adenovirus Conjunctivitis?

Yes, crusting of the eyelids and lashes is a recognized feature of adenoviral conjunctivitis, though it is typically less prominent than the watery discharge that characterizes this infection. 1

Clinical Presentation of Adenoviral Conjunctivitis

Adenoviral conjunctivitis presents with several characteristic features that help distinguish it from other causes of red eye:

Primary Discharge Pattern

• Watery to serofibrinous discharge is the hallmark of adenoviral infection, distinguishing it from the purulent discharge of bacterial conjunctivitis 2, 3
• The discharge in epidemic keratoconjunctivitis (the most severe form) is described as watery with associated hyperemia and chemosis 3

Eyelash and Eyelid Margin Findings

• Crusting of the eyelashes is specifically mentioned as part of the comprehensive slit-lamp examination for conjunctivitis 1
• The guideline explicitly lists "crusting" under eyelash examination findings when evaluating any form of conjunctivitis, including viral etiologies 1
• While crusting is more characteristic of bacterial conjunctivitis (which causes purulent discharge that mats the eyelids, especially on waking), it can occur with adenoviral infection as the watery discharge dries on the lashes 2

Other Key Clinical Features

• Follicular reaction on the inferior tarsal conjunctiva 2, 4
• Bulbar conjunctival injection (redness) 2, 4
• Preauricular or periauricular lymphadenopathy 2, 3
• Bilateral involvement, though may start unilaterally 2

Important Clinical Distinctions

Adenovirus vs. Bacterial Conjunctivitis

The quality and quantity of crusting differs significantly between viral and bacterial causes:

• Bacterial conjunctivitis produces green or yellow purulent/mucopurulent discharge that causes significant matting and crusting, particularly upon waking 2
• Adenoviral conjunctivitis produces primarily watery discharge, so any crusting is typically lighter and less adherent 2, 3

Severe Adenoviral Disease

• In severe cases, adenoviral conjunctivitis can develop pseudomembranes, which are associated with higher rates of severe sequelae including conjunctival/subtarsal scarring 2
• These pseudomembranes represent a more serious manifestation than simple crusting 1

Clinical Pitfall to Avoid

Do not assume that the presence of crusting automatically indicates bacterial conjunctivitis requiring antibiotics. 4 The key distinguishing features are:

• Bacterial: thick, purulent discharge with heavy matting and crusting 2
• Adenoviral: watery discharge with possible light crusting, accompanied by follicles, preauricular adenopathy, and often systemic symptoms (fever, pharyngitis in pharyngoconjunctival fever) 2, 3

Examination Recommendations

When evaluating for adenoviral conjunctivitis, specifically assess:

• Eyelash examination for presence and character of crusting 1
• Tarsal conjunctiva (by everting the lower lid) for follicular reaction 2
• Preauricular lymph nodes by palpation 2, 4
• Cornea with fluorescein staining to detect subepithelial infiltrates or progression to epidemic keratoconjunctivitis 2