LYCEUM- NORTHWESTERN UNIVERSITY

COLLEGE OF NURSING

Related Learning Experience

CASE STUDY:
VIRAL
CONJUNCTIVITIS

BOLASOC, HAZEL

BONALOS, CHARMAE JANE

CABATBAT, FRENZY DIANE

CANCINO, ANGELA ANN

I. INTRODUCTION

Conjunctivitis, also known as pink eye, is an inflammation of the conjunctiva. This is a protective
membrane that covers the visible white part of the eye and the inner side of the eyelid. Conjunctivitis is
a common cause of eye redness and subsequently a common complaint in the emergency department,
urgent care, and primary care clinics. It can affect people of any age, demographic or socioeconomic
status. Although usually self-limiting and rarely resulting in vision loss, when assessing for
conjunctivitis, it is essential to rule out other sight-threatening causes of red-eye.

Conjunctivitis refers to the inflammation or infection of the conjunctiva. It can be acute or chronic
and infectious or non-infectious. Acute conjunctivitis refers to symptom duration 3 to 4 weeks from
presentation (usually only lasting 1 to 2 weeks) whereas chronic is defined as lasting more than 4 weeks.

Conjunctivitis is the most prevalent etiology of eye redness and discharge. Infectious
conjunctivitis can result from bacteria, viruses, fungi, and parasites. However, 80% of acute cases of
conjunctivitis are viral, the most common pathogen being Adenovirus. Adenoviruses are responsible for
65 to 90% of cases of viral conjunctivitis.

BIOGRAPHIC DATA:

Name: Mr. X

Age: 4 years old

Diagnosis: Initial Diagnosis - Conjunctivitis

Final Diagnosis - Conjunctivitis

ADMISSION NOTE: Cough and Colds

MEDICAL HISTORY:

Personal health history: No asthma

Family History:

(+) asthma (paternal)

(+) smoker (Father)

Past medical history:

(+) 2 weeks of sore eyes.

Present medical history:

(+) noted “gound” and redness in both eyes

ROS:

(-) headache (-) chest pain (-) seizure

(-) loss appetite (-) difficulty of breathing (+) itchy throat
(-) no vomiting (-) yellow urine with adequate output

II. OBJECTIVES

General:
To understand viral conjunctivitis, appropriate nursing management, prognosis, and its prevalence.
Specific:
● To describe the common etiologies of viral conjunctivitis.
● To recognize the different causes of viral conjunctivitis.
● To identify the management strategies and appropriate nursing care intervention for patients
with viral conjunctivitis.
● To explain the importance of improving care coordination and enhancing the prompt and
thorough delivery of care to patients with viral conjunctivitis.

III. OVERVIEW OF ANATOMY AND PHYSIOLOGY

The conjunctiva is a thin layer of clear tissue that lines the inside of the eyelid and covers the
white of the eye (sclera). This mucous membrane secretes fluids to keep the eye moist and protect it
from foreign bodies and infections. It's also involved in tear production. The conjunctiva is made up of
cells and tissues that serve specific functions. These include goblet cells that secrete mucus and a layer
of cells called the stratified squamous epithelium that provide structural stability. The conjunctiva itself
is divided into three segments. The bulbar conjunctiva is the segment that covers the sclera but not the
cornea (the clear dome in front of the eye). The palpebral conjunctiva is the segment that covers the
inner surface of the upper and lower eyelids. The fornix conjunctiva is a flexible segment between the
bulbar and palpebral conjunctiva that allows the eyelid and eyeball to move freely. These segments form
a continuous "closed" structure that prevents objects, like contact lenses, from slipping behind the
eyeball.

The primary function of the conjunctiva is to lubricate the eye by producing mucus and tears. Together,
these fluids form a layer, called the tear film, which consists of the innermost mucus layer, the middle
watery layer, and the outer oily layer. The tear film serves several important functions:

● Barrier protection: The tear film creates a barrier against harmful microorganisms like bacteria
or viruses. It also protects the cornea from grit and things that can cause scratches.
● Lubrication: The tear film allows the eyelid to open and shut smoothly without irritation. The
outermost oily layer also prevents the evaporation of fluids, ensuring consistent levels of moisture
between blinks.
● Visual acuity: Together, the layers of fluids create a smooth optical surface that we need for
good, non-distorted vision.
● Eye health: The tear film contains substances that promote wound healing, suppress,
inflammation, neutralize free radicals, and create a hostile environment for bacteria and other
disease-causing organisms.

While the lacrimal glands are tasked with producing the watery portion of tears, the conjunctiva can also
produce these fluids, albeit in smaller quantities.
IV. DESCRIPTION OF THE DISEASE

Viral conjunctivitis is caused by non-enveloped double-stranded DNA Virus adenoviruses,

rubella virus, rubeola (measles) virus, herpesviruses, varicella-zoster viruses, Epstein-Barr viruses,
which also cause infectious mononucleosis (mono), picornaviruses. Among these viruses, viral
conjunctivitis cases are usually caused by adenoviruses which is the same virus that causes a runny nose
and sore throat in people with the common cold. Localized viral conjunctivitis without systemic
manifestations usually results from adenoviruses (up to 90% of viral conjunctivitis) and sometimes
enteroviruses or herpes simplex virus (1.3 to 4.8% of viral conjunctivitis). Typically, viral conjunctivitis
begins in one eye and then spreads to the other which usually occurs in epidemics. It is highly contagious
because the viral particles of viral conjunctivitis survive on dry surfaces for weeks.

The main symptoms of viral conjunctivitis include pinkness or, often, intense redness of the eye,
itching, tearing, gritty with burning sensation, mild pain, light sensitivity, swollen eyelids and
conjunctiva, watery discharge from the other symptoms of viral infection, such as sore throat, runny
nose, and cold symptoms. Visual acuity is usually at or near their baseline vision. Epidemic
keratoconjunctivitis (EKC) is the most severe ocular infection caused by adenovirus. The cornea can be
affected by the viral replication in the epithelium and anterior stroma leading to superficial punctate
keratopathy and subepithelial that can decrease vision and cause light sensitivity. The conjunctiva is
injected (red) and can also be edematous. In some cases, a membrane or pseudomembrane can be
appreciated in the tarsal conjunctiva. Some of the features that differentiate viral and bacterial
conjunctivitis includes purulence of ocular discharge, presence of preauricular lymphadenopathy, and,
in epidemic keratoconjunctivitis chemosis. The majority of viral conjunctivitis patients will have
follicles present, but the presence of papillae does not rule out a viral etiology. Palpation of the
preauricular lymph nodes may reveal a reactive lymph node that is tender to the touch and will help
differentiate viral conjunctivitis to bacterial.

Conjunctivitis accounts for 1% of all primary care and emergency room visits. The incidence of
viral conjunctivitis is approximately 80,000 per 100,000 cases with acute conjunctivitis. (As viral
conjunctivitis can be highly contagious, infected individuals should be counseled to prevent transmission
such as washing hands frequently during the period of contagion. Most cases of acute, infectious
conjunctivitis are viral and self-limited; these cases do not require antimicrobial treatment.
 V. PATHOPHYSIOLOGY ETIOLOGY

Adenovirus

Modifiable Factors Risk Factors Non-Modifiable Factors

Direct contact with a person Age

infected with viral (Children under 5 years old)
conjunctivitis

Sharing personal
items (washcloths,
face towels)

Unhygienic practices
(not washing hands)

Always touching or
rubbing eyes (hand-
to-eye contact)

Upper respiratory
tract infections
(cough & colds)

Contaminated water
(ex. Swimming
pools)
Viral Conjunctivitis

Edema of the Dilation of the conjunctival Hyperemia of the

conjunctiva blood vessels conjunctiva

One Eye infected

Both Eye infected

Eye discharge Redness of Eyes Swollen eyelid

Eye boogers (dry

Watery Eyes Eye pain
rheum)

Eye itchiness (mild)

Eyes Discomfort
VI. LABORATORY AND DIAGNOSTIC TEST

The doctor can diagnose the condition by taking the patient’s history and the appearance of the
eye. In rare cases, laboratory tests may be required.

Physical Examination: The doctor uses bright light to evaluate the external structures of the eye.
Slit Lamp Examination: The doctor uses a slit lamp—an instrument that consists of a microscope and
a high-energy beam of light to view structures of the eye like conjunctiva and cornea under magnification
to rule out corneal involvement and presence of any membrane, papillae, or follicles on the conjunctiva
and determine the severity of the infection.
Visual Acuity Tests: Doctors also check to see if conjunctivitis has affected your vision by conducting
a visual acuity test.
Eye Culture: During this test, your doctor takes a sample of the cells on the inside of your eyelids with
a cotton swab and sends it to a laboratory to be examined by a pathologist, who studies diseases under a
microscope, can determine whether your conjunctivitis is caused by viruses or bacteria. This helps your
doctor determine the most effective treatment.

VII. MEDICAL MANAGEMENT

Drug Name Classification Indications Side Effects Nursing

Implications

Generic Name: Pharmacologic: Is a multivitamin Nausea, stomach > Assess the

Multivitamins Water Soluble formulated to upset, diarrhea, patient for any
Vitamins provide children 1- drowsiness, hypersensitivity to
Brand Name: 12 years old flushing, and this drug.
Enervon® Vitamins A, B, C numbness/tinglin
Syrup and D that help g may occur. > Instruct the
boost energy and patient’s guardian
immunity during to administer this
periods of drug once a day
increased physical per orem or as
activities, rapid prescribed by the
growth, and doctor.
development.
> Instruct the
patient’s guardian
Dosage Mechanism of Contraindications Adverse Effects to administer this
Action drug to his child
Syrup: It works hand in Hypersensitivity to CNS: rarely - a with meals for
● 1-3 years hand with food to retinol palmitate state of arousal. better absorption
is 2.5mL provide the (Vitamin A), Cardiovascular or if
- 5mL synergistic Cholecalciferol system: rarely - gastrointestinal
(1/2 to 1 benefits of B- (Vitamin D3), pain in the heart, discomfort occurs.
teaspoonf vitamins (namely Thiamine tachycardia.
ul) B1, B2, B6, B12) Hydrochloride Allergic > Inform the
● 4-12 and Vitamin C to (Vitamin B1), reactions: rarely - patient's guardian
years is the body. Riboflavin urticaria. that an overdose
5m (1 Vitamins B1 and (Vitamin B2), of this medication
teaspoonf B2 help in the Pyridoxine may cause
ul) body’s food-to- Hydrochloride stomach upset or
Available bottle energy conversion (Vitamin B6), diarrhea.
sizes: process. Vitamins Cyanocobalamin
● 60 mL, B6 and B12 are (Vitamin B12),
120 mL, important in Niacinamide,
250 mL, lowering Dexpanthenol and
500 mL homocysteine Ascorbic acid
Route: levels and creating (Vitamin C).
Oral red blood cells,
 which are vital in
transporting
nutrients through
the body. Vitamin
C helps keep the
immune system up
and can also act as
an antioxidant by
neutralizing
unstable
molecules that can
damage cells.

Other medication/treatment:

● Proper Eye Hygiene

- Regular and complete daily hygiene of eyes is important. This is applicable for both
patients who receive treatment and in healthy people. Air pollution, unclean water,
unhygienic hands, the act of rubbing eyes are all potential sources of infections which can
cause eye disorders, such as viral conjunctivitis. Patient can use eye-friendly and eye
doctor recommended lid wipes to clean upper eyelids, lower eyelids and the entire eye
closed.
● Cold Compress
- Cold compresses can relieve the symptoms of various eye problems, such as
conjunctivitis (pink eye). Using a cold compress may ease the swelling and redness
associated with pinkeye. People using a cold compress should ensure that it is clean
before use and wash it after every use. Patient should gently place the compress on a
closed eye. The NEI recommends keeping a cold compress on an eye injury for 15
minutes. It is fine to repeat the treatment as necessary every couple of hours.

VIII. NURSING CARE PLAN/ NCP

ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION

Problem: Short-term Goal: Independent Nursing STG: GOALS

The mother and a After 15 minutes Intervention: WERE MET
4-year-old boy of nursing Assess vital signs To have a baseline After 15 minutes
come to the interventions, the and help determine if of nursing
hospital together patient and mother there is an interventions, the
to have a check-up will be able to: underlying systemic patient and mother
of his son with a ● Express the infection. Pink eyes were able to
chief complaint of reduction of usually do not express the
cough and cold, discomfort. present with a fever. reduction of
discomfort, eye ● Verbalize discomfort,
discharge, and 2 understanding Obtain history from To determine the verbalize the
weeks of sore of avoiding the patient and parents, cause of his understanding of
eyes. cross- depending on the condition if other avoiding the
contamination patient’s age. members of the cross-
Subjective: of viral family in the home contamination of
“Namumula ang conjunctivitis. have similar viral
kanyang mata 2 ● Express symptoms. Then, conjunctivitis, and
weeks na at laging understanding isolate the patient express
may muta of how to from these family understanding of
pagkagising niya. alleviate the members. how to alleviate
Iyak ng iyak dahil signs and the signs and
hindi siya symptoms. Use proper PPE such as Bacterial and viral symptoms.
comfortable at gloves and disinfect all conjunctivitis are
spread through
makati ang Long-term Goal: equipment used per contact. Disinfect all
kanyang After 1 week of facility protocol. equipment to prevent LTG:
lalamunan” as nursing cross-contamination Goals are met if
verbalized by the interventions, the with other patients. the patient takes
patient’s mother. patient will be able
Applying a cold or his multivitamins,
to report that bothwarm compress; a clean Make sure the performs regular
Objective: eyes feel more cloth that has been compress is moist hand washing/
● Crying comfortable. soaked in water; to the and cold or warm hygiene, avoids
● Uncomfortable eye (not hot) to help touching or
● Redness of After 2 weeks of relieve discomfort. rubbing his eyes to
eyes nursing Advise the patient to alleviate the
● Crusty interventions, the perform regular hand To reduce the risk of symptoms and
appearance patient’s hygiene, avoid touching infecting other clear up viral
around the conjunctivitis will the affected eye people at home or in conjunctivitis and
eyes clear up and especially when he is the community and stays at home to
relieve discomfort. coughing, and limit to prevent such limit physical
V/S taken as close physical contact severe complications. contact with
follows: with others. others. If the
Temp: 36.6 °C mother changes
HR: 100 bpm Educate patients and Help patients and the pillowcases
RR: 24 bpm parents/caregivers on parents/caregivers often, apply a cold
proper hygiene and how understand the or warm
to prevent the further importance of proper compress, and
Nursing spread of infection: care and hygiene to clean eye
Diagnosis: prevent the spread of discharge with a
Alteration in Eye ● Clean eye infection to other clean cloth.
Comfort related to discharge with a children or family
Viral Infection of tissue (dispose of members.
Conjunctiva as carefully), a clean
evidenced by cloth, or cotton
redness of eyes, wool soaked in
eye discharge, and clean water.
crusty appearance ● Do not share
around the eyes. towels or clothing
with others.
● Change pillow
cases often.

Dependent Nursing
Intervention:
Give multivitamins as Multivitamins can
ordered by the contribute to
physician. antioxidant health,
and help keep your
child's immune
system healthy and
fortified.
Collaborative
Management:
Encourage patient and Doctors also check to
parents to have a visual see if the
acuity test. conjunctivitis has
affected your vision
by conducting a
visual acuity test.
IX. EVALUATION AND DISCHARGE PLANNING

Health Teaching:
The client was advised the following:

● Don't touch your eyes with your hands.

● Wash your hands often.
● Use a clean towel and washcloth daily.
● Don't share personal care items such as towels or washcloths.
● Change your pillowcases often.
● Educate the patient on the disease
● Take medications as prescribed (Multivitamins)
● Use artificial tears if the eye is irritated
● Stay at home until symptoms subside
● Wear sunglasses when going out

REFERENCES:

https://www.msdmanuals.com/professional/eye-disorders/corneal-disorders/introduction-to-corneal-
disorders
https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis?fbclid=IwAR1vSDz4w8TZ3Iz-
vXgo2LwfrViQGYnXmAqj94lZvt6DRhcqsF-EM-bQN1g \
https://www.cdc.gov/conjunctivitis/clinical.html#:~:text=Viral%20conjunctivitis%20is%20highly%20
contagious,respiratory%20discharges%20can%20contaminate%20hands.
https://www.ncbi.nlm.nih.gov/books/NBK470271/#:~:text=Patients%20with%20viral%20conjunctiviti
s%20present,of%20the%20eyelids%20upon%20waking.
https://www.msdmanuals.com/professional/eye-disorders/corneal-disorders/introduction-to-corneal-
disorders
https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis?fbclid=IwAR1vSDz4w8TZ3Iz-
vXgo2LwfrViQGYnXmAqj94lZvt6DRhcqsF-EM-bQN1g
https://www.ncbi.nlm.nih.gov/books/NBK541034/
https://nyulangone.org/conditions/conjunctivitis/diagnosis