The eyes are red, now what?
Adenovirus conjunctivitis is highly symptomatic, causing discomfort, redness, photophobia, and tearing in patients. ZIKV conjunctivitis is no different. That being said, even those with an active ZIKV illness may be asymptomatic or present with minimal complaints.
Despite the symptoms, a good case history is essential in making the diagnosis.
If you encounter a patient with an acute conjunctivitis that cannot be attributed to any other cause, further questioning is crucial. Lack of recent travel to an infected country does not rule out ZIKV as potential cause. Transmission may occur through blood transfusion or from a spouse or household member with recent travel to an active illness area.3, 8,10
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Depending on when this patient presents to you in the incubation period, they may or may not have any node involvement, but a quick check of the preauricular nodes can help confirm a viral diagnosis. On slit lamp examination, does the patient have any follicles, chemosis, or sub-epithelial infiltrates? If clinical findings lend support to the viral diagnosis, although not specific to ZIKV, the use of the Rapid Pathogen Screening (RPS) AdenoPlus Detector may be warranted to rule out other viral causes. As ZIKV is a self-limiting condition, artificial tears and cold compresses may be the most appropriate form of treatment to relieve discomfort. If the patient presents early in the course of the infection, ophthalmic Betadine 5% (povidone iodine, Alcon) may significantly improve symptoms. Although there is documentation of infection via bodily fluids,3 to date there have been no reports of ZIKV transmission through conjunctivitis. The patient should still be counseled on hygiene to prevent further viral transmission.
A complaint of retro-orbital pain, although non-specific to ZIKV, warrants further evaluation. However as often is the case, the patient’s history should provide better context to the reported symptoms, especially onset and modifying or associated factors. Ophthalmic examination of the extraocular muscles, and evaluation of the optic nerve appearance and visual fields can help rule out differential diagnosis of neurologic conditions or a lesion in the brain. Acetaminophen may be recommended for short-term pain management.
If additional systemic symptoms of ZIKV are noted, the patient should follow up with his primary-care provider as soon as possible.