Clinical Characteristics and Mixed Infection Patterns of Ocular Surface Infection with Epstein-Barr Virus

Purpose To analyze the clinical features of ocular surface diseases caused by Epstein-Barr virus (EBV) infection. Methods A retrospective case series study was conducted. Data from 48 patients (54 eyes) with EBV infection who visited Peking University Third Hospital between January 2023 and October 2025 were collected. Patient demographics and baseline information were recorded. Ophthalmic slit-lamp examination, ocular surface (conjunctiva/cornea) scrapings, bacterial culture of ocular secretions, real-time fluorescence quantitative PCR detection, EBV-specific antibody testing, and metagenomic next-generation sequencing (mNGS) were performed. Results Among patients infected with EBV on the ocular surface, the majority were middle-aged individuals in the 31–40 age group. The primary risk factors for onset were keeping pets (10/48), followed by colds (6/48); among those keeping pets, parrots were the most common (5/9). The main clinical manifestations were foreign body sensation (37/54) and yellow discharge (34/54). Common signs included mixed conjunctival hyperemia (31/54), follicles on the lower eyelid conjunctiva (17/54), papillae on the upper eyelid conjunctiva (8/54), and punctate epithelial defects on the cornea (17/54). In most ocular surface scrapings, small round lymphocytes were observed alongside a small number of reactive lymphocytes (44/54), which could simultaneously present with a large number of neutrophils (34/54). There was a significant difference between the presence of yellow discharge and the type of conjunctival hyperemia (\(\:{\text{χ}}^{\text{2}}\text{=}\text{9.}\text{818,P}\text{=0.007}\)). However, no statistically significant correlation was found between the presence of yellow discharge and the presence of neutrophils in the scraping results (\(\:{\text{χ}}^{\text{2}}\text{=0.}\text{64,P}\text{>0.05}\)). Significant differences were found in EBV viral loads among different groups of combined symptoms (\(\:\text{F=4.}\text{207,P}\text{=0.02}\)) and among different follicle groups (\(\:\text{F=4.}\text{466,P}\text{=0.007}\)). No statistically significant correlation was found between the lymphocyte count in the scraping and the EBV viral load in the affected eye (\(\:\text{F=0.}\text{49,P}\text{>0.05}\)). Conclusion EBV infection of the ocular surface is prone to concurrent infections; therefore, a detailed medical history inquiry is crucial. Ocular surface tissue scraping examination can rapidly and effectively aid in diagnosis.