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Adenoviral Infection (PCF)

Subjective

A six-year-old child presents with a two-day history of a left red eye (Fig. 1). The child has had an upper respiratory infection with a mild sore throat and low-grade fever for the past two days. The mother states the child's left eye has had a mild watery discharge with no matter. The child has no known exposure not been exposed to anyone with a red eye over the past three weeks.

Fig. 1 The secondary inflammation gives the impression that the left eye is smaller, thus explaining why the ancients referred to this disease as "small eye," which is termed "pink eye" today.

Objective

• VA: OD 6/6 (20/20); OS 6/9 (20/30)
• External examination: small palpable preauricular lymphadenopathy on the left side
• Conjunctiva: 2+ hyperemia to the left bulbar conjunctiva with a mild serous discharge and a mild follicular response to the inferior palpebral conjunctiva OS
• Cornea and anterior chamber are uninvolved
  

Assessment

• Pharyngoconjunctival fever (PCF)
  

Plan

• Patient and parent education regarding the self-limited nature and possible contagious potential of this infection
• No school until the serous/watery discharge and redness have resolved
• Loteprednol etabonate 0.2% 1 gt. q.i.d. OS until the acute phase of the infection dissipates
• Recheck in 5 days. There is a 50% improvement in the conjunctival involvement. Continue the loteprednol etabonate 0.2% b.i.d. OS for 4 more days, then discontinue
• Follow-up p.r.n.

Comments: The treatment here could have consisted of cold compresses, artificial tears, or decongestant/antihistamine combinations. In moderate and symptomatic cases, steroid eye drops are indicated to suppress the inflammation created by the toxicity of the primary adenoviral condition.  

Pharyngoconjunctival Fever (PCF)

• Usually seen in children with a triad of mild sore throat, low-grade fever, and conjunctivitis (occasionally hemorrhagic)
• Runs a 10- to 14-day self-limiting course
  
• Keratitis, if present, is usually mild and superficial
• Supportive measures may be indicated, such as cold compresses, mild vasoconstrictors, artificial tears, etc.

This concludes the discussion of the PCF form of Adenoviral Infections. There is a more comprehensive summary of adenoviral infections under the Epidemic Keratoconjunctivitis (EKC) case.