Viral conjunctivitis. How to recognize and treat acute conjunctivitis Viral conjunctivitis ICD 10

The clinical picture of adenoviral conjunctivitis manifests itself 5-8 days after infection. At the beginning of the disease, there is an increase in body temperature with pronounced symptoms of pharyngitis and rhinitis, headache, and dyspeptic disorders; submandibular lymphadenitis develops.
  During the second wave of fever, signs of conjunctivitis appear, first in the area of ​​one eye, and after 2-3 days - in the other eye. Local symptoms of adenoviral conjunctivitis are characterized by swelling and redness of the eyelids, light mucous or mucopurulent discharge, foreign body sensation, itching and burning, lacrimation, photophobia, and moderate blepharospasm. Hyperemia is expressed in all parts of the conjunctiva, extending to the lacrimal caruncle, semilunar and lower transitional fold.
  The catarrhal form of adenoviral conjunctivitis occurs with minor symptoms of local inflammation: slight redness of the eye mucosa, a moderate amount of discharge. The course of catarrhal adenoviral conjunctivitis is mild, the duration of the disease is about one week. Usually there are no complications from the cornea.
  The follicular form of adenoviral conjunctivitis is characterized by the presence of vesicular rashes (follicles) on the mucous membrane of the eye. Follicles can be small, pinpoint or large, translucent and gelatinous; located in the corners of the eyelids or covering the entire infiltrated and loosened mucous membrane, especially in the area of ​​the transitional fold. The follicular reaction superficially resembles the initial stage of trachoma, however, there are usually no diagnostic errors, since with trachoma there are no symptoms of nasopharyngitis or fever, and the rash is localized in the conjunctiva of the upper eyelid.
  The filmy form of adenoviral conjunctivitis occurs in a quarter of cases. It occurs with the formation of thin grayish-white films covering the mucous membrane of the eye. Usually the films are delicate and can be easily removed with a cotton swab; but sometimes dense fibrinous deposits may form, adhered to the conjunctiva, which are difficult to remove from the inflamed mucosa. After removing the films, the exposed mucosa may bleed. Sometimes pinpoint subconjunctival hemorrhages and infiltrates are detected, which completely resolve after recovery. The outcome of membranous adenoviral conjunctivitis is often mucosal scarring. With membranous adenoviral conjunctivitis, the general condition suffers: a high fever develops (up to 38°C–39°C), which can last from 3 to 10 days. The filmy form of adenoviral conjunctivitis can be mistaken for diphtheria.

Viral infection is a process familiar to the human body. Every day, millions of viruses attack it in an attempt to break through protective barriers and find a suitable habitat. In most cases, immune cells successfully cope with their task. Nevertheless, people get sick, and most often these are lesions of the mucous membranes - the oral cavity, nose and nasopharynx, as well as the conjunctiva (mucous membrane of the eyes).

Definition of disease

For the adult population, viral eye damage in 80% of cases means an adenoviral infection, and if pus later appears in the eyes, this means that, through the fault of the patient himself, bacteria have joined the disease.

In childhood, viral and bacterial infections occur with approximately the same frequency, however, even here the adenovirus predominates among the viruses.

Most often, outbreaks of adenovirus infection occur in children's groups, where they spread very quickly in the spring and autumn. This is due to a temporary decrease in immunity due to adaptation to climatic conditions. However, there are also sporadic (random) spread of infection, again in children's groups.

In the adult population, infection most often affects older people and, as a rule, is single.

Types and classifications

Depending on the strength of the symptoms, as well as their nature, the following forms of the disease are distinguished:

• Catarrhal. Most often, the disease takes the catarrhal form, which is the easiest to cure and can last within 7 days. The healing period depends on the age of the patient, as well as the state of his immunity. Characterized by minimal symptoms: slight mucous discharge, slight swelling of the eyelids and redness of the eyes;
• Filmy. A characteristic sign is the formation of a gray-white film on the eye, which can be easily removed with a cotton swab. If adequate treatment is not available, scar formation on the mucous membrane is possible. This form can last up to 12 days and is accompanied by general weakness and high t;

• Follicular. This form is characterized by the most severe symptoms and serious complications. The surface of the mucous membrane is covered with follicles (vesicles) of various sizes, which, without adequate treatment, cause scarring of the cornea.

The course of adenoviral conjunctivitis can be acute (pronounced symptoms and rapid progression) and subacute (moderate rate of disease development with moderate symptoms).

Causes

The main reason for the development of the disease is viral infection, which can occur in 2 ways:

• Airborne. When a patient nearby sneezes or coughs, the virus with droplets of sputum enters the mucous membrane of a healthy person, where it successfully takes root. The source of infection can also be a healthy person - virus carriage sometimes persists up to 4 weeks from the onset of infection;
• Fecal-oral. This method of infection is typical for small children aged 0.5 - 5 years. Up to 6 months The baby is protected by transplacental immunity. Breastfed babies are also protected by antibodies obtained from their mother's milk.

Factors that provoke the introduction of adenovirus include:

• Violation of personal hygiene;
• Hypothermia;
• Swimming in dirty water (pools or ponds);
• Failure to follow the rules for caring for or wearing contact lenses;
• Stress;
• ARVI;

Surgical correction of the cornea

Any condition that requires the immune system to work harder can weaken it and open the door to infection.

Symptoms

Adenoviral infection, when introduced into the body, affects not only the mucous membrane of the eyes. First of all, general symptoms appear: rhinitis and pharyngitis, dyspeptic disorders, increased temperature and headache, enlarged submandibular lymph nodes.

Later, signs of conjunctivitis appear: redness and swelling of the eyelids, foreign body sensation, burning and itching, photophobia and lacrimation, mucous (sometimes mixed with) discharge, moderate.

Depending on the form of the disease, symptoms may vary:

• Catarrhal. Symptoms occur in the mildest form and do not last more than a week;
• Follicular. A characteristic feature is numerous follicles on the mucosa, which can be pinpoint, large or small, localized in the corners of the eyelids or covering the entire mucosa;
• Filmy. This form accounts for up to 25% of all cases of the disease. Grayish-white films are usually easily removed. However, sometimes they take the form of dense fibrinous deposits, which are fused to the conjunctiva and are difficult to remove. As a result of their removal, the mucous membrane may begin to bleed. Therefore, with this form of infection, scars often form on the surface of the mucosa.

When diagnosing, the membranous form is differentiated from diphtheria, and the follicular form from trachoma.

Possible complications

If the infection occurs in a catarrhal form, and treatment is carried out on time, then the risk of complications is minimal. With the development of more severe types of disease, complications are possible:

• Toxic-allergic or. The addition of bacterial infection or signs of inflammation of an allergic nature can develop as a result of decreased immunity or increased susceptibility of the mucous membrane to toxins secreted by microorganisms;
• . Damage to the conjunctiva leads to a decrease in the production of tear fluid and the development of uncomfortable sensations: dryness and burning, increased eye fatigue, lacrimation and photophobia;

Dry eye syndrome

• . Inflammatory damage to the cornea, often accompanied by the formation of scars and ulcers, which invariably leads to decreased visual acuity;
• Otitis, adenoiditis, tonsillitis. Inflammation of the middle ear, tonsils, as well as the proliferation of lymphoid tissue in the nasopharynx can result from a viral infection of the mucous membrane of the respiratory tract and eustachian tube.

A viral infection without adequate treatment can lead to serious changes in the transparency of the cornea and cause partial or complete loss of vision.

Diagnostics

When conducting a diagnosis, the doctor finds out the duration and strength of the symptoms, as well as their nature. Moreover, not only the signs of eye disease are important, but also the deterioration of the general condition of the body. The medical history also includes information about the patient’s suspected contact with adenovirus-infected people.

Particular attention is paid to bacteriological research:

• Conjunctival smear;
• Bacteriological culture;
• Cytological scraping.

Diagnosis of adenoviral conjunctivitis

Such tests make it possible to differentiate from bacterial lesions. A mandatory point is an examination using a slit lamp, which allows you to assess the extent of damage to the eye tissues. To identify a viral infection, the most informative technique is PCR (polymerase chain reaction).

Treatment

Treatment is carried out mainly on an outpatient basis and does not present any particular difficulties when it comes to mild forms of the disease. If complications of follicular or membranous conjunctivitis develop, hospitalization is possible.

Drug therapy

Conservative treatment methods are the main ones when choosing therapeutic tactics. The choice of necessary medications occurs under the supervision of a doctor strictly individually. Drugs from the following groups can be used:

• Antiviral: Interferon, Laferon;

Interferon eye drops

• Antibacterial: , . Necessary when a bacterial infection occurs or for its prevention - as prescribed by a doctor;
• Antibacterial ointments: Levomycetin. Placed at night once a day to prevent secondary infection;
• Glucocorticosteroids: Hydrocortisone, Dexamethasone. Used to reduce the manifestations of inflammation: swelling, redness. They are used in extreme cases because they suppress the immune system.

Treatment of adenoviral conjunctivitis should be timely and competent, and should only be carried out under the supervision of a doctor. Otherwise, the infection may spread to adjacent tissues and lead to decreased vision.

Folk remedies

In most cases, a viral infection with a good level of immunity is successfully suppressed by the body itself. As a rule, treatment does not require the use of strong drugs. Therefore, the use of folk remedies in some cases can be an effective addition to medications:

• Grind the burdock roots, pour 3 tbsp boiling water. l. raw materials until completely covered, leave and rinse eyes with filtered infusion;
• Pour 250 ml of boiling water over blue cornflower flowers (1 tbsp.), boil for 10 minutes. over low heat and leave until almost completely cooled. Use as a solution for rinsing and lotions. Additionally, introduce fish oil and liver into the diet;
• Dilute agave juice with boiled water (1:10) and drop 2 drops into the eyes several times during the day;
• Make an infusion of chamomile or calendula flowers (1 tbsp per 200 ml of water), strain and rinse your eyes;
• As an antiviral agent, use aromatic eucalyptus oil or cut garlic into a saucer and place it in the room;
• Use sour milk for washing, it perfectly eliminates inflammation of the mucous membrane.

When using even folk remedies, consulting an ophthalmologist will not be superfluous. However, if this is not possible, try to carefully observe all dosages and storage conditions of the drugs, and even better, prepare fresh ones daily.

Prevention

Measures to prevent adenoviral conjunctivitis are no different from the prevention of all viral infections:

• Strict adherence to personal hygiene rules;
• Timely isolation of an infected patient, especially in a children's group;
• Elimination of chronic foci of infection and treatment of viral diseases;
• Constant care for a high level of immunity: a balanced diet, consumption of vitamins (natural and synthetic), hardening, playing sports or gymnastics, walking in the fresh air;
• Wet cleaning and ventilation.

In fact, the body can cope with viruses on its own, even if it has not encountered them before. However, for this he must have strong immunity, the presence of which is a guarantee of protection against viruses.

Video

conclusions

As a rule, adenoviral conjunctivitis develops after a runny nose and pharyngitis. Therefore, with the right actions at the very beginning, infection can be completely avoided.

However, if this does happen, do not let the disease take its course and visit a doctor, even if you are not going to take strong medications. After all, the virus can have a completely different nature and serious complications in case of inadequate therapy.

The main obstacle to infection can be the immune system. Strengthen it in every possible way, and not only with pharmacy vitamins. After all, natural food gives the body not only vitamin components and essential microelements, but also supplies tissues with building material to create new cells to replace dead ones. That is why give preference to natural fish and meat over ready-made sausages or canned food. This will help to avoid slagging of the body and will also serve to strengthen the immune system.

B30.8 + Other viral conjunctivitis (H13.1*). B30.9. Viral conjunctivitis, unspecified. H16. Keratitis. H16.0. Corneal ulcer. H16.1. Other superficial keratitis without conjunctivitis. H16.2. Keratoconjunctivitis (epidemic B30.0+ H19.2*). H16.3. Interstitial (stromal) and deep keratitis. H16.4. Neovascularization of the cornea. H16.9. Keratitis, unspecified. H19.1* Herpes simplex virus keratitis and keratoconjunctivitis (B00.5+).
Adenoviruses cause two clinical forms of eye disease: adenoviral conjunctivitis (pharyngoconjunctival fever) and epidemic keratoconjunctivitis (more severe and accompanied by damage to the cornea). In children, pharyngoconjunctival fever often occurs, and epidemic keratoconjunctivitis occurs less frequently.

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Adenoviral conjunctivitis (pharyngoconjunctival fever)
The disease is highly contagious and is transmitted by airborne droplets and contact. Mostly children of preschool and primary school age in groups are affected. Conjunctivitis is preceded by a clinical picture of acute catarrh of the upper respiratory tract with symptoms of pharyngitis, rhinitis, tracheitis, bronchitis, otitis, dyspepsia, and an increase in body temperature to 38-39 ° C.
The incubation period is 3-10 days. Both eyes are affected with an interval of 1-3 days. Characterized by photophobia, lacrimation, swelling and hyperemia of the skin of the eyelids, moderate hyperemia and infiltration of the conjunctiva, scanty serous-mucous discharge, small follicles, especially in the area of ​​transitional folds, and pinpoint hemorrhages. Less commonly, pinpoint subepithelial infiltrates of the cornea are formed, disappearing without a trace. In children, delicate grayish-white films may form, which, when removed, reveal the bleeding surface of the conjunctiva. The pre-auricular lymph nodes are enlarged and painful. Lasts no more than 10-14 days.
Epidemic keratoconjunctivitis
It is highly contagious, spreads by contact, and less commonly by airborne droplets. Infection often occurs in medical institutions. The duration of the incubation period is 4-10 days.
The onset is acute, affecting both eyes. Against the background of moderate respiratory manifestations, almost all patients experience enlargement and tenderness of the parotid lymph nodes. The course is severe: films often form on the conjunctiva and hemorrhages. On the 5-9th day from the onset of the disease, pinpoint subepithelial (coin-shaped) infiltrates appear on the cornea, leading to decreased vision. In their place, persistent corneal opacities form. The duration of the infectious period is 14 days, the duration of the disease is 1-1.5 months.

Epidemic hemorrhagic conjunctivitis
It is less common in children than in adults. The causative agent is enterovirus-70, transmitted by contact; It is highly contagious, spreads “explosively”, the incubation period is short (12-48 hours).
Edema of the eyelids, chemosis and infiltration of the conjunctiva, single small follicles on the lower transitional fold, moderate mucous or mucopurulent discharge. Hemorrhages into and under the conjunctival tissue are characteristic. Sensitivity

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the cornea is reduced, sometimes pinpoint subepithelial infiltrates occur, quickly and completely disappearing after a few days. The preauricular lymph nodes are enlarged and painful. The duration of the disease is 8-12 days, ending with recovery.
Treatment of viral conjunctivitis Adenoviral conjunctivitis Interferons (ophthalmoferon*) in instillations from 6-10 times a day in the acute period to 2-3 times a day as the severity of inflammation subsides. Antiseptic and antibacterial agents for the prevention of secondary infection (picloxidine, fusidic acid), levofloxacin, moxifloxacin or miramistin). Anti-inflammatory (diclofenac, diclofenaclong*), antiallergic (ketotifen, cromoglycic acid) and other drugs. Tear substitutes (hypromellozadextran or sodium hyaluronate) 2-4 times a day (if there is insufficient tear fluid).
Epidemic keratoconjunctivitis and epidemic hemorrhagic conjunctivitis
To local treatment, similar to the treatment of adenoviral conjunctivitis, for corneal rashes or film formation, it is necessary to add: GK (dexamethasone) 2 times a day; drugs that stimulate corneal regeneration (taurine, dexpanthenol), 2 times a day; tear replacement drugs (hypromellozadextran, sodium hyaluronate).
Herpetic keratoconjunctivitis and keratitis
Primary herpetic keratoconjunctivitis
Develops in the first 5 years of a child’s life after primary infection with the herpes simplex virus. The disease is often unilateral, with a long and sluggish course, and is prone to relapses. It manifests itself in the form of catarrhal or follicular conjunctivitis, less often - vesicular ulcerative. The discharge is insignificant, mucous. Characterized by recurrent eruptions of herpetic blisters, followed by the formation of erosions or ulcers on the conjunctiva and the edge of the eyelid, covered with delicate films, with reverse development without scarring. Possible

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severe systemic manifestations of herpes infection, such as encephalitis.
Herpetic keratitis
Develop after hypothermia, febrile conditions. One eye is affected, and the sensitivity of the cornea is reduced. Characterized by slow regeneration of ulcerated lesions, a weak tendency to vascularization, and a tendency to relapse.
Herpetic epithelial keratitis
In appearance, vesicular, stellate, dotted, tree-like, tree-like with stromal lesions, card-shaped. Epithelial opacities or small vesicles form. Merging, bubbles and infiltrates form a peculiar shape of a tree branch.
Herpetic stromal keratitis
Herpetic stromal keratitis is somewhat less common, but it is classified as a more severe pathology. In the absence of ulcerations, it can be focal, with the localization of one or several foci in the superficial or middle layers of the corneal stroma. With stromal keratitis, an inflammatory process of the vascular tract almost always occurs with the appearance of precipitates and folds of Descemet's membrane.
Discoid keratitis
Discoid keratitis is characterized by the formation of a rounded infiltrate in the middle layers of the stroma in the central zone of the cornea. Characterized by the presence of precipitates (sometimes they are poorly visible due to corneal edema) and the rapid effect of using HA.
Herpetic corneal ulcer
A herpetic corneal ulcer can result from any form of ophthalmoherpes. Characterized by a sluggish course, decreased or absent sensitivity of the cornea, and occasionally pain. When a bacterial or fungal infection is attached, the ulcer rapidly progresses, deepens, and even perforates the cornea. In this case, the outcome may be the formation of a fused cataract with a prolapsed iris or the penetration of infection inside, endophthalmitis or panophthalmitis with subsequent death of the eye.
Herpetic keratouveitis
With herpetic keratouveitis, there are symptoms of keratitis (with or without ulceration), but signs of damage to the vascular tract predominate. Characterized by the presence of infiltrates in various layers of the corneal stroma, deep folds of Descemet's membrane, precipitates, exudate in the anterior chamber, newly formed vessels in the iris, posterior synechiae. Often

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Bullous changes in the epithelium and frequent increases in intraocular pressure develop in the acute period of the disease.
Treatment of herpetic keratoconjunctivitis and keratitis Antiherpetic drugs (acyclovir in the form of eye ointment 5 times in the first days and 3-4 times thereafter), or interferons (ophthalmoferon *), or a combination thereof 6-8 times a day. Antiallergic (olopatadine) 2 times a day and anti-inflammatory drugs (diclofenac, diclofenaclong*, indomethacin) 2 times a day locally.
For herpetic keratitis additionally: mydriatics (atropine); stimulators of corneal regeneration (taurine, dexpanthenol 2 times a day); tear replacement drugs (hypromellozadextran 3-4 times a day, sodium hyaluronate 2 times a day).
To prevent secondary bacterial infection - picloxidine or miramistin 2-3 times a day.
For severe corneal edema and ocular hypertension, use: betaxolol (Betoptik*), eye drops 2 times a day; brinzolamide (azopt*), eye drops 2 times a day.
Local use of HA is necessary for stromal keratitis and is contraindicated for keratitis with corneal ulceration. It is possible to use them after epithelization of the cornea to accelerate the resorption of infiltration and the formation of more delicate corneal opacities. It is safer to start instillations with low concentrations of dexamethasone (0.01-0.05%), which are prepared ex tempore, or add the drug for parabulbar injections.
Depending on the severity and severity of the process, systemic antiviral drugs (acyclovir, valacyclovir) in tablets and for intravenous administration, and systemic antihistamines are also used.
Conjunctivitis caused by molluscum contagiosum virus
The pathogen is classified as a dermatotropic poxvirus. Molluscum contagiosum affects various areas of the skin, including the face and eyelids. The transmission route is contact-household.
Single or multiple nodules the size of a pinhead appear on the skin. The nodules are dense, with a pearlescent sheen, painless, with a “belly button” depression in the center and a whitish cheesy content. Join

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Rubella
Caused by a virus of the Togaviridae family. Against the background of general clinical manifestations (catarrh of the upper respiratory tract, generalized and painful lymphadenopathy, slight increase in body temperature, small rash in the form of pale pink spots), catarrhal conjunctivitis and superficial keratitis occur. The outcome of the disease is favorable.

ICD 10 conjunctivitis is a disease that causes inflammation of the mucous membrane of the eye. Its signs may be redness, itching, irritation, pain when exposed to rays of light, excessive tearing for no reason, etc.

Like most diseases, conjunctivitis is included in ICD 10, the international medical classification of diseases. It is confirmed by the relevant document and is used throughout the world.

How to find conjunctivitis according to ICD

In the international classification, conjunctivitis corresponds to code H10. Moreover, as is known, this disease has several varieties, which are also listed in the ICD:

• H10.0 – purulent;
• H10.1 – ;
• H10.2 – all sharp;
• H10.3 – acute, unspecified;
• H10.4 – chronic;
• H10.5 – ;
• H10.8 – others;
• H10.9 – unspecified.

A number of conjunctivitis not listed in this list are designated in international documentation using codes H10–H13, depending on the characteristics.

The ICD classification allows doctors and pharmacists from different countries to determine the disease and methods of its treatment, which allows them to use treatment methods that have already been proven in practice. And it is also used when released for export by some countries, and by others when purchased and used, knowing in what case they should be used.

Types and characteristics of the disease

Like other diseases, conjunctivitis comes in two forms:

• spicy;

The acute form occurs suddenly and is characterized by a sharp manifestation of symptoms, severe pain, pain, redness and itching. Chronic, on the other hand, involves repeated manifestations of the disease, and its course is not as pronounced as in the first case. In this case, both eyes become inflamed, and symptoms appear gradually.

Conjunctivitis is also divided into the following types:

1. Viral disease develops, as a rule, in parallel with other viral diseases, progresses quickly and affects both eyes, is characterized by profuse lacrimation and purulent discharge, and can also be accompanied by damage to other otorhinolaryngeal organs.
2. Bacterial is a consequence of damage by coccal bacteria, is distinguished by purulent grayish discharge, due to its thick consistency the eyelids stick together, and also affects the skin around the eyes.
3. Fungal is a consequence of the effect of fungi on the mucous membrane.
4. An allergy is caused by an allergenic irritant and may be accompanied by damage to the mucous membrane of the respiratory tract.
5. Chemical appears as a result of damage to the mucous membrane by toxic substances; the only symptoms present are pain.
6. Medicinal is a side effect of the use of certain medications, symptoms include burning and lacrimation.

This classification is used when establishing a treatment method, which depends on the form and.

Treatment of the disease

Treatment of each type of conjunctivitis has its own characteristics. If an allergic or medicinal type manifests itself, it is necessary to limit contact with the allergen, which will lead to a weakening of the symptoms, and subsequently complete relief from them. If it is impossible to interrupt contact, antihistamine blockers are used.

Important! Despite the fact that conjunctivitis, code H10 according to the ICD, is a common disease, you should never self-medicate. If any symptoms occur, be sure to see a doctor.

Viral types are treated with special drops, but in addition, do not forget that, as a rule, in this case, conjunctivitis has concomitant diseases, which should also be gotten rid of.

In the case of bacterial diseases, the doctor must prescribe medications that attack the source of the problem, and ointments are used to relieve symptoms. Fluoroquinol drugs are also used.