PMC4574852_01
Clinical presentation of bilateral ocular CA24v infection.. Notes: (A) First day morning; (B) first day afternoon; (C) second day am; (D) second day pm; (E) third day am; (F) fourth day pm; (G) sixth day pm. The bilateral lid edema (*), vascular dilation, and conjunctival erythema were noted on the second day, and the inferior-nasal chemosis (arrow) was present on the third day post-AHC. The clinical signs were less and resolved more quickly in the right (second infected) than the left (first affected) eye.. Abbreviations: CA24v, coxsackievirus A24; AHC, acute hemorrhagic conjunctivitis.
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A 60-year-old male presented with foreign body sensation in the left eye and symptoms of conjunctivitis (Figure 1) ~24 hours after possible laboratory exposure to AHC virus. An external ocular examination of the left eye revealed lid edema, tearing, conjunctival erythema, dilated conjunctival blood vessels predominantly in the inferior temporal and nasal bulbar conjunctiva, and small blotches of subconjunctival hemorrhage in the inferior bulbar conjunctiva of the left eye (Figure 1A) that progressed through the day (Figure 1B). The onset of conjunctivitis in the right eye occurred in the evening/night of the second day 36-48 hours (Figure 1C). The bilateral tearing, conjunctival erythema, and swelling increased through 24 hours, remained through 48 hours, and diminished by day 6 (Figure 1C and F). The right eye signs and symptoms were generally less intense than in the left eye with the noted exception of a transient chemosis involving the infra-nasal bulbar conjunctival on day 3 that resolved in 24 hours (Figure 1D).