Keratoconjunctivitis

Background

• Defined as concurrent inflammation of both the cornea and conjunctiva.
• Multiple etiologies:
  • Atopic keratoconjunctivitis: common in patients with atopy(ie: eczema, allergies, asthma, rhinitis)
  • Epidemic keratoconjunctivitis: highly contagious viral(Adenovirus) conjunctivitis, associated with watery discharge
  • Keratoconjunctivitis photoelectrica(subtype of UV Keratitis)
  • Keratoconjunctivitis sicca: associated with autoimmune disorders such as Sjogren's Syndrome, Sarcoidosis, Rheumatoid arthritis, and Schleroderma

Clinical Features

• intense itching
• excessive tearing
• burning sensation
• clear mucus discharge
• conjunctival erythema/hyperemia
• blurred vision
• photophobia
• foreign body sensation
• Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
• Chronic inflammation may eventually lead to vision loss

Differential Diagnosis

• Viral conjunctivitis
• Bacterial conjunctivitis
• Allergic conjunctivitis
• Acute angle closure glaucoma
• Uveitis
• Keratitis(eg: HSV)
• Corneal abrasian
• Trauma/Foreign body
• Chemical exposure
• Dacryocystitis
• Reactive arthritis
• Cluster headache

Evaluation

• Generally a clinical diagnosis
• Fluorescein test followed by tonometry:
  • Fluorescein test if concerned for abrasians, corneal damage, foreign body, globe rupture
  • Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye

Management and Disposition

Based on likely etiology and severity:

Severity:

• Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
• Moderate/Severe: should be referred to Ophthalmologist

Etiology:

• Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist
• Epidemic keratoconjunctivitis: usually self-resolving
• Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
• Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist

References

Hamrah, MD et.al. Atopic keratoconjunctivitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Munoz, MD et.al. Diagnosis, treatment, and prevention of adenovirus infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinallis emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education; 2016.