Hemorrhagic conjunctivitis

Disease Description (Causes and Symptoms)

• Definition and causes
  • Acute hemorrhagic conjunctivitis is a type of viral conjunctivitis caused mainly by enteroviruses (especially Enterovirus 70) or, less commonly, coxsackievirus A24. It is highly contagious.
  • Incubation period: Usually 8–48 hours (however, this may vary depending on the type of virus).
• Pathophysiology
  • The virus invades the conjunctiva (the white part of the eye), causing acute inflammation and resulting in subconjunctival hemorrhage, conjunctival swelling, and formation of papillae and follicles. In some patients, corneal involvement may occur and cause reduced vision.
• Main symptoms
  • Sudden conjunctival redness (red eye), eye pain, irritation, foreign-body sensation, excessive tearing, photophobia, and eye discharge
  • Subconjunctival hemorrhage (red spots or extensive bleeding on the white part of the eye), eyelid swelling, and follicular or papillary changes in the conjunctiva
  • In about 25% of cases, systemic symptoms such as fever, general malaise, and muscle aches occur
• Contagiousness and course
  • Route of transmission: Direct contact with discharge from an infected eye or indirect contact through contaminated towels, bedding, or objects.
  • Contagiousness is strongest in the early stage of illness (especially during the first week), and the disease may generally remain contagious for about 1–2 weeks.
  • Most cases improve within several days to 1–2 weeks, but recovery may take several weeks or longer if the cornea is involved.

Treatment Methods (Standard Treatment · Medications · Procedures/Surgery · Lifestyle Management · Precautions)

• General principles
  • As there is no specific antiviral medication, conservative and symptomatic treatment is generally recommended.
• Medication treatment
  • Topical antibiotics prescribed by a doctor (such as antibiotic ointment or eye drops) may be used to prevent secondary bacterial infection.
  • Topical nonsteroidal anti-inflammatory drug (NSAID) eye drops or oral analgesics may be used to relieve pain and inflammation (follow the doctor’s instructions).
  • Do not use steroid eye drops without clear instructions from a doctor (improper use may worsen viral or herpetic keratitis).
• Procedural treatment
  • If a pseudomembrane (membrane) forms on the conjunctiva and causes reduced vision or discomfort, a doctor may carefully remove it (bleeding may occur during removal).
• Lifestyle management (self-care)
  • Wash your hands frequently and do not touch your eyes.
  • Use separate towels, toiletries, bedding, cups, and other items.
  • Do not wear contact lenses (until you have completely recovered).
  • Applying a cold compress may help relieve early symptoms.
  • Get sufficient rest at home and avoid public swimming pools, public bathhouses, and other shared-use facilities.
• Precautions and contraindications
  • Seek ophthalmologic care immediately if symptoms are severe or if there is reduced vision, severe pain, persistent or worsening redness/discharge, or severe systemic symptoms.
  • Use steroid eye drops only under the judgment of a specialist.
• Risk of complications
  • Corneal opacity (reduced vision), corneal ulcers, chronic dry eye, conjunctival scarring, and stenosis of the lacrimal punctum may rarely occur.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare and information to record
  • A list of medications currently being taken (including eye drops) and a history of allergies
  • The date symptoms began and their course (when they started, which eye was affected first, the time until both eyes became involved, etc.)
  • Photos of the symptoms (if possible, taken with a smartphone) — these can help with comparison during the examination
  • Whether contact lenses are used, recent use of swimming pools or public bathhouses, and contact with anyone with similar symptoms (family, school, or workplace)
  • Whether there have recently been systemic symptoms such as fever or muscle aches, and a history of previous eye diseases (such as herpetic keratitis)
• Examples of questions medical staff are likely to ask during an outpatient visit
  • "When did the symptoms begin? Did they initially affect one eye?"
  • "Do you use contact lenses? Were you wearing lenses recently?"
  • "Has anyone in your family or among your coworkers had similar symptoms?"

General Examples of Questions to Ask the Doctor

• What are the main side effects of this medication (the prescribed eye drops or oral medication)?
• If my symptoms do not improve or worsen, when (after how many days) should I come back?
• In daily life, which activities should I particularly avoid, and what precautions should I take (including when to resume wearing contact lenses and when to return to work or school)?

Examples of Condition-Specific Questions

• I have developed conjunctival bleeding or redness. How can this be distinguished from simple viral hemorrhagic conjunctivitis and other conditions such as herpetic keratitis or bacterial conjunctivitis? (Is additional testing necessary?)
• If corneal involvement is suspected (reduced vision, punctate opacity, etc.), what tests will be performed, and what is the expected future visual prognosis?