Manifestation of the disease viral conjunctivitis is

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manifestation of the disease. Viral conjunctivitis is highly contagious; it is spread by direct contact with the patient and his or her secretions or with contaminated objects and surfaces. Viral conjunctivitis typically presents as injection; watery or mucoserous discharge and a burning, sandy, or gritty feeling in one eye. Patients may report "pus" in the eye, but on further questioning they have morning crusting followed by watery discharge, perhaps with some scanty mucus throughout the day. The second eye usually becomes involved within 24 to 48 hours, although unilateral signs and symptoms do not rule out a viral process. Patients often believe that they have a bacterial conjunctivitis that has spread to the fellow eye; On examination there is typically only mucoid discharge if one pulls down the lower lid or looks very closely in the corner of the eye. Usually there is profuse tearing rather than discharge. The tarsal conjunctiva may have a follicular or "bumpy" appearance. There may be an enlarged and tender preauricular node. Viral conjunctivitis is a self-limited process. The clinical course parallels that of the common cold. While recovery can begin with days, the symptoms frequently get worse for the first three to five days, with very gradual resolution over the following one to two weeks for a total course of two to three weeks. Just as a patient with a cold can have morning coughing and nasal congestion or discharge two weeks after symptoms first arise, patients with viral conjunctivitis may have morning crusting two weeks after the initial symptoms, although the daytime redness, irritation, and tearing should be much improved. Allergic conjunctivitis — Allergic conjunctivitis is caused by airborne allergens contacting the eye that, with specific immunoglobulin E (IgE) and the release of chemical mediators including histamine, eosinophil chemotactic factors, and platelet-activating factor, among others. It typically presents as bilateral redness, watery discharge, and itching. Itching is the cardinal symptom of allergy, distinguishing it from a viral etiology, which is more typically described as grittiness, burning, or irritation. Eye rubbing can worsen symptoms. Patients with allergic conjunctivitis often have a history of atopy, seasonal allergy, or specific allergy (eg, to cats). Similar to viral conjunctivitis, allergic conjunctivitis causes diffuse injection with a follicular appearance to the tarsal conjunctiva and profuse watery or mucoserous discharge. There may be morning crusting. It is the complaint of itching and the history of allergy or hay fever as well as a recent exposure that allows the distinction between allergic and viral conjunctivitis; the clinical findings are the same. In some cases of allergic conjunctivitis, there is marked chemosis (conjunctival edema); in extreme instances, there can be bullous chemosis, in which the bulging, edematous conjunctiva extends forward beyond the lid margins. Bullous chemosis is most commonly seen in patients

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