Viral conjunctivitis

A 41-year-old patient attended for an eye examination and wanted to try contact lenses for the first time. On slit-lamp examination, each eye showed several discrete white opacities spread randomly across the cornea. They varied from around 0.25mm to 1mm in diameter and did not stain. A section suggested they were actually stromal. What are they likely to be and is this patient suitable for contact lenses?

The clinical editor replies: A useful question to ask the patient with this sort of presentation is 'did you have a severe bout of conjunctivitis some weeks ago?' These anterior stromal lesions are most likely residual infiltrates from adenoviral keratoconjunctivitis. Every eye care practitioner needs to know the signs of an adenoviral keratoconjunctivitis, as the condition is best managed with careful hygiene and avoidance of cross-contamination. For this reason, anyone presenting with signs of viral conjunctivitis (watery discharge, follicles on the tarsal plate, bilateral diffuse hyperaemia and perhaps swollen glands or flu-like symptoms) should have their corneas closely examined. Depending on the virus, there may well be corneal involvement.