Clinical manifestations of acute conjunctivitis. A. Acute viral conjunctivitis. Conjunctival erythema is visible in most cases of viral conjunctivitis. B. Acute viral conjunctivitis. Conjunctival erythema, chemosis and tearing are present due to ocular irritation. C. Acute conjunctivitis with significant subconjunctival hemorrhage, severe chemosis, and extensive discharge. In addition to lubrication, such cases require topical steroids for symptomatic relief and should be referred for ophthalmic consultation. D. Adenoviral conjunctivitis. Examination in an ophthalmology clinic routinely involves fluorescein staining to assess for associated corneal epithelial keratopathy. Tearing, conjunctival hyperemia and chemosis, and secretions are evident.