Pharyngoconjunctival Fever

Increased redness of the eye. Adrian Samson

Pharyngoconjunctival fever is a condition characterized by a fever, sore throat and follicular conjunctivitis. Pharyngoconjunctival fever, also known as PCF, is often seen in school children because they are in close quarters and is caused by a virus.

Pharngoconjunctival fever is highly contagious during the first few days. After 10 or 15 days the communicability is almost zero. The incubation period of the virus is 5-12 days and people suffering from it can have a fever for up to ten days.

Patients who have PCF also complain of fatigue and upset stomach.

People suffering from PCF also have a pharyngitis. A pharyngitis is an inflammation of the throat that appears reddened and is covered with bumps called follicles. They also have swollen lymph nodes in the neck region.

Eye complaints and signs appear within 48 hours of onset and are:

  • itching
  • burning
  • gritty sensation
  • tearing
  • discharge
  • mild light sensitivity
  • swollen eyelids
  • redness

People who develop PCF develop a general redness of the eye that begins on the red lower part of the inside of the eyelids and extends onto the globe of the eye. This gives the conjunctiva (the clear tissue that lines the inside of the eyelids and that lies on top of the white part of the eye) a gelatinous, swollen appearance. Also, small clear bumps called follicles will be present on the conjunctiva. Although it occurs in both eyes, one eye usually seems worse.

As the disease progresses, the cornea, the clear dome like structure on the front part of the eye, becomes inflamed. Small white lesions called subepithelial infiltrates often develop. These infiltrates are immune cell complexes that develop in response to the virus. Subepithelial infiltrates may remain for quite some time and usually do not affect vision unless they occur in the center of the cornea.

In this case, people will complain of blurry vision or glare around lights.

Another complication of PCF is the development of a pseudomembrane. A pseudomembrane is a false membrane made of inflammatory debris and mucous that usually­­ forms on the conjunctiva under the upper eyelid. Pseudomembranes make patients very uncomfortable. If present, doctors usually recommend removing them using anesthetic and forceps.

Treatment of pharyngoconjunctival fever is aimed at reducing symptoms since it is considered a self-limited disease. Self-limiting means that the illness goes through a cycle and then disappears eventually. As a result, we know that people will eventually feel better and treatment is designed to manage symptoms to make the patient feel better.

Most treatment involves using artificial tears given 4-8 times per day for a few weeks. Also, cold compresses have been shown to alleviate symptoms. Optometrists and Ophthalmologists also recommend a vasoconstrictor/antihistamine eye drop commonly described as a “get-the-red-out” drop.  A vasoconstrictor with an antihistamine will alleviates the intense itching that some people with pharngoconjunctival fever develop.

Pharmaceuticals are prescribed for certain patients.

Occasionally, patients may be at risk for developing a bacterial superinfection. In this case, antibiotic eye drops may be used.

Depending on the amount of inflammation involved and the presence of subepithelial infiltrates and pseudomembranes, steroids may be prescribed with caution. Steroids are helpful but must be used carefully and tapered over a long period of time. Steroids are not recommended in the early phase because it may actually enhance viral cell replication. Also steroids are known to worsen underlying conditions such as herpetic eye infection that may mimic pharngoconjunctival fever.

Antivirals are being investigated for pharyngoconjunctival fever but are not commonly prescribed at this time.

Also Known As: PCF

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