Acute hemorrhagic conjunctivitis is a highly contagious acute ophthalmic infection caused by picornaviruses, affecting the conjunctiva of the eyes and accompanied by massive subconjunctival hemorrhages. Acute hemorrhagic conjunctivitis occurs with severe hyperemia, swelling and chemosis of the mucous membrane, pain in the eyes, photophobia, serous-purulent discharge, subconjunctival hemorrhages that occur against the background of common symptoms (adenopathy of the anterior lymph nodes, headache, fever, tracheobronchitis, etc.). For the purpose of differential diagnosis, biomicroscopy of the eye, fluorescein instillation test, serological, virological and cytological studies are performed. Treatment is carried out with the help of instillations of antiviral, antiallergic and antibacterial drugs.
B30.3 Acute epidemic hemorrhagic conjunctivitis
More than half of conjunctivitis occurring in clinical ophthalmology have a suspected or proven viral genesis. Almost all viruses known to date that cause human diseases have a tropicity to the tissues of the eye. The most common forms of viral eye infection are herpesvirus conjunctivitis, adenovirus conjunctivitis and acute hemorrhagic conjunctivitis.
Acute hemorrhagic conjunctivitis is a disease described relatively recently. The pandemic of acute hemorrhagic conjunctivitis was first recorded in West and North Africa in 1969 and then spread to the countries of Asia and the Middle East.
The causative agent is picornavirus (enterovirus type 70, ESNO, Coxsackie A-24, etc.). The disease is characterized by high contagiousness, and therefore proceeds in the form of locally limited outbreaks at enterprises, children’s institutions, as well as epidemics of the “explosive” type, covering a large number of persons.
Transmission of the virus is carried out by contact through hands contaminated with eye secretions, objects (towels, pillows, etc.), infected eye drops, instruments (pipettes, eye sticks), ophthalmic devices, etc. If anti-epidemic measures are not followed in teams, 80-90% of people can be affected by acute hemorrhagic conjunctivitis.
Acute hemorrhagic conjunctivitis is characterized by a short incubation period (from 12 to 48 hours). At first, one eye is usually affected, after 1-2 days – the other.
The disease manifests acutely and is accompanied by severe pain and pain in the eyes, photophobia, lacrimation, a feeling of a foreign body in the eye, the presence of a mucous or mucopurulent discharge in the conjunctival cavity. A feature of the clinic of acute hemorrhagic conjunctivitis is a sharp infiltration of the conjunctiva, often leading to chemosis, pronounced hyperemia of the mucosa, against which multiple subconjunctival hemorrhages are distinguished. Hemorrhages can take the form of small petechiae or massive hemorrhages that spread to the entire conjunctiva of the sclera. Small follicular eruptions are detected on the transitional fold of the eyelid.
The phenomena of keratitis in acute hemorrhagic conjunctivitis are expressed moderately and are characterized by a decrease in the sensitivity of the cornea, multiple small-point subepithelial infiltrates. The reverse development of corneal infiltrates, despite the active treatment of acute hemorrhagic conjunctivitis, occurs extremely slowly, sometimes for several months.
Local symptoms unfold against the background of common symptoms: malaise, headache, fever, tracheitis and bronchitis. Enlargement and tenderness of the anterior lymph nodes (lymphadenitis) are typical.
In general, pronounced clinical manifestations last from 10 days to 2 weeks. A trace reaction in the form of discomfort during visual work, sensations of a foreign body in the eye can be observed for a long time. With relapses of this disease, uveitis may develop.
The diagnosis of acute hemorrhagic conjunctivitis is established on the basis of clinical and epidemiological features of the disease: registration of an outbreak of the disease, pathognomonic symptoms (conjunctival hemorrhages, follicular rashes, superficial keratitis, etc.). Sometimes, if the ocular symptoms are ignored, acute hemorrhagic conjunctivitis can be mistaken for ARVI or influenza. Proper diagnosis is facilitated by consultation of the patient with an ophthalmologist and an infectious disease specialist.
- Eye examination. Biomicroscopy is used in the examination of patients with acute hemorrhagic conjunctivitis. During the study, hyperemia, subconjunctival hemorrhages of various sizes and shapes, small point follicles are detected.
- Instillation tests. The presence of small point infiltrates on the cornea is detected during a staining test with fluorescein.
- Clarifying laboratory diagnostics. It is carried out with the help of virological, serological and cytological examination of scraping from the conjunctiva.
Differential diagnosis of acute hemorrhagic conjunctivitis is carried out with adenovirus and allergic conjunctivitis, electrophthalmia, snow blindness, injuries and foreign bodies of the conjunctival cavity.
Detection requires localization of the outbreak focus, if possible – isolation of patients and contact persons. Treatment is carried out with the help of antiviral agents: instillations into the conjunctival sac of interferon solutions and its inducers are prescribed. Topical antiallergic and anti-inflammatory therapy with the use of corticosteroids in low concentrations is carried out simultaneously.
To exclude secondary bacterial complications, instillation of antimicrobial drops and application of eye ointments is prescribed. Instillations of solutions of dextran, potassium iodide, and hyaluronidase are used for the purpose of rapid resorption of corneal infiltrates. Active therapy is continued for at least two weeks.
Prognosis and prevention
Usually, the course ends with complete recovery without consequences for visual function. There is no stable immunity to infection, so re-infection is possible.
To prevent the spread of ophthalmic infection, it is necessary to identify and isolate patients, carry out strict sanitary and hygienic measures in the outbreak site, and carefully process ophthalmic instruments and equipment.