Viral conjunctivitis: a retrospective study in an Australian hospital


      • Most red eye patients presenting to the ED are already on antibiotics
      • About 3–5% of conjunctivitis is caused by the Herpes Simplex Virus
      • Pseudomembranous conjunctivitis is commonly caused by adenovirus



      To update the literature on the current trends of viral conjunctivitis infections in Sydney, Australia.


      To find correlations between viral and patient characteristics on disease outcomes and to assess the rates of antibiotic and steroid use in patients with viral conjunctivitis prior to and after assessment by ophthalmology trainees.


      Retrospective single-centre case series.


      368 eyes of 224 patients diagnosed with viral conjunctivitis at the Sydney Eye Hospital from 1 st January - 31 st March 2017.


      Patients were identified from hospital records or polymerase chain reaction results.


      368 eyes of 224 patients, median age 35.3 (range 7–82) and 59.8% males, were included. 152 (67.9%) patients presented already on antibiotic treatment. Most patients (83.5%) had no previous ocular history aside from 35 (15.6%) who were regular contact lens wearers. PCR was performed in 170 (75.9%) patients, with 92 (54.1%) positive for adenovirus, and 7 (4.1%) for HSV. The average duration of symptoms prior to presentation was 6.3 days. 177 (78.0%) patients presented within 1 week of symptom onset and these patients were more likely to be adenovirus positive on PCR (OR = 2.37). Patients with symptoms of longer duration were more likely to have photophobia (OR = 2.96) and have had steroid treatment (OR = 3.80).

      Conclusions and relevance

      Patients with viral conjunctivitis typically presented within a week of symptom onset, with bilateral disease and on topical antibiotics. Pseudomembranes and a palpable preauricular lymph node were not common. As treatments emerge for viral conjunctivitis patients may need to be encouraged to present earlier.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contact Lens and Anterior Eye
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American academy of ophthalmology. Conjunctivitis.
        American Academy of Ophthalmology, San Francisco, CA2003
        • Keen M.
        • Thompson M.
        Treatment of acute conjunctivitis in the United States and evidence of antibiotic overuse: isolated issue or a systematic problem?.
        Ophthalmology. 2017; 124: 1096-1098
        • Udeh B.L.
        • Schneider J.E.
        • Ohsfeldt R.L.
        Cost effectiveness of a point-of-care test for adenoviral conjunctivitis.
        Am J Med Sci. 2008; 336: 254-264
        • Stasiuk R.M.
        • Robertson I.F.
        Adeno-viral kerato conjunctivitis.
        Aust J Ophthalmol. 1981; 9: 55-58
        • McMinn P.C.
        • Stewart J.
        • Burrell C.J.
        A community outbreak of epidemic keratoconjunctivitis in central Australia due to adenovirus type 8.
        J Infect Dis. 1991; 164: 1113-1118
        • Schepetiuk S.K.
        • Norton R.
        • Kok T.
        • Irving L.G.
        Outbreak of adenovirus type 4 conjunctivitis in South Australia.
        J Med Virol. 1993; 41: 316-318
        • Adlhoch C.
        • Schöneberg I.
        • Fell G.
        • Brandau D.
        • Benzler J.
        Increasing case numbers of adenovirus conjunctivitis in Germany, 2010.
        Eurosurveillance. 2010; 15: 19707
        • Jhanji V.
        • Chan T.C.
        • Li E.Y.
        • Agarwal K.
        • Vajpayee R.B.
        Adenoviral keratoconjunctivitis.
        Surv Ophthalmol. 2015; 60: 435-443
        • Zhang L.
        • Zhao N.
        • Sha J.
        • Wang C.
        • Jin X.
        • Amer S.
        • et al.
        Virology and epidemiology analyses of global adenovirus-associated conjunctivitis outbreaks, 1953–2013.
        Epidemiol Infect. 2016; 144: 1661-1672
        • Dart J.K.
        • Stapleton F.
        • Minassian D.
        Contact lenses and other risk factors in microbial keratitis.
        Lancet. 1991; 338: 650-653
        • Kaufman H.E.
        Adenovirus advances: new diagnostic and therapeutic options.
        Curr Opin Ophthalmol. 2011; 22: 290-293
        • Mitsui Y.
        • Hanna L.
        • Hanabusa J.
        • Minoda R.
        • Ogata S.
        • Kurihara H.
        • et al.
        Association of adenovirus type 8 with epidemic keratoconjunctivitis: special reference to the infantile form of the disease.
        AMA Arch Ophthalmol. 1959; 61: 891-898
        • National Center for Health Statistics
        • Ganley J.P.
        • Roberts J.
        Eye conditions and related need for medical care among persons 1-74 years of age, United States.
        2019: 1971-1972
        • Rietveld R.P.
        • Ter Riet G.
        • Bindels P.J.
        • Schellevis F.G.
        • van Weert H.C.
        Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice.
        BMC Fam Pract. 2007; 8: 54
        • Everitt H.
        • Little P.
        How do GPs diagnose and manage acute infective conjunctivitis? A GP survey.
        Fam Pract. 2002; 19: 658-660
        • Australian New Zealand Clinical Trials Registry [Internet]: Sydney (NSW)
        • NHMRC Clinical Trials Centre, University of Sydney (Australia)
        Identifier ACTRN12619000177156. A phase 2, Multi-centeR, randomized, DoUBle-Masked, placebo-controlled StudY to evaluate the clinical safety and efficacy of OKG-0301 in the treatment of acute adenoviral conjunctivitis (RUBY); 2019 jul 12 [cited 2019 July 3rd]; [1 page].
        (Available from:)2005
        • Kilduff C.
        • Lois C.
        Red eyes and red-flags: improving ophthalmic assessment and referral in primary care.
        Bmj Open Qual. 2016; 5: u211608-w4680
        • Edwards K.
        • Keay L.
        • Naduvilath T.
        • Stapleton F.
        A population survey of the penetrance of contact lens wear in Australia: rationale, methodology and results.
        Ophthal Epidemiol. 2009; 16: 275-280
        • Alipour F.
        • Khaheshi S.
        • Soleimanzadeh M.
        • Heidarzadeh S.
        • Heydarzadeh S.
        Contact lens-related complications: a review.
        J Ophthalmic Vis Res. 2017; 12: 193
      2. The Royal Australian and New Zealand College of ophthalmologists.
        Chloramphenicol use in ophthalmic practice. 2018 (June Retrieved from)
        • Bennett S.
        • Carman W.F.
        • Gunson R.N.
        The development of a multiplex real-time PCR for the detection of herpes simplex virus 1 and 2, varizella zoster virus, adenovirus and Chlamydia trachomatis from eye swabs.
        J Virol Methods. 2013; 189: 143-147
        • Uchio E.
        • Takeuchi S.
        • Itoh N.
        • Matsuura N.
        • Ohno S.
        • Aoki K.
        Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1.
        Br J Ophthalmol. 2000; 84: 968-972
        • Elnifro E.M.
        • Cooper R.J.
        • Klapper P.E.
        • Yeo A.C.
        • Tullo A.B.
        Multiplex polymerase chain reaction for diagnosis of viral and chlamydial keratoconjunctivitis.
        Invest Ophthalmol Vis Sci. 2000; 41: 1818-1822
        • Sambursky R.
        • Trattler W.
        • Tauber S.
        • Starr C.
        • Friedberg M.
        • Boland T.
        • et al.
        Sensitivity and specificity of the AdenoPlus test for diagnosing adenoviral conjunctivitis.
        JAMA Ophthalmol. 2013; 131: 17-21
        • Kam K.R.
        • Ong H.S.
        • Bunce C.
        • Ogunbowale L.
        • Verma S.
        Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study.
        Br J Ophthalmol. 2015; (Apr 8:bjophthalmol-2014)
        • Holtz K.K.
        • Townsend K.R.
        • Furst J.W.
        • Myers J.F.
        • Binnicker M.J.
        • Quigg S.M.
        • et al.
        An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.
        Mayo Clin Proc Innov Qual Outcomes. 2017; 1: 170-175
        • Özen Tunay Z.
        • Ozdemir O.
        • Petricli I.S.
        Povidone iodine in the treatment of adenoviral conjunctivitis in infants.
        Cutan Ocul Toxicol. 2015; 34: 12-15
        • Pinto R.D.
        • Lira R.P.
        • Abe R.Y.
        • Zacchia R.S.
        • Felix J.P.
        • Pereira A.V.
        • et al.
        Dexamethasone/povidone eye drops versus artificial tears for treatment of presumed viral conjunctivitis: a randomized clinical trial.
        Curr Eye Res. 2015; 40: 870-877
        • Yirrell D.L.
        • Darville J.M.
        • Armstrong A.G.
        • Irish M.J.
        A correlation between the weather and the incidence of ocular adenovirus infections.
        Arch Virol. 1986; 91: 367-373