Epidemic keratoconjunctivitis: Difference between revisions

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==Background==
==Background==
*Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis
*Form of [[viral conjunctivitis]] that causes keratitis in addition to conjunctivitis
*Vision-threatening
*Caused by [[adenovirus]] infection that is highly contagious and tends to occur in epidemics
*Caused by adenovirus infection that is highly contagious and tends to occur in epidemics
**Highly contagious and potentially vision-threatening<ref name="Meyer">Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C. Epidemic Keratoconjunctivitis: The Current Situation and Recommendations for Prevention and Treatment. Deutsches Ärzteblatt International. 2011;108(27):475-480. doi:10.3238/arztebl.2011.0475.</ref>
**Transmitted via contact with infectious fluids (commonly tear fluid) on hands, tissues, etc<ref name="Meyer" />
 
[[File:EKC.png|thumb|Subepithelial infiltrates in EKC]]


==Clinical Features==
==Clinical Features==
*Often preceded by cough, high fever, malaise, myalgias, N/V
*Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.<ref name="Meyer" />
*Usual symptoms of viral conjunctivitis plus:
*Can be preceded by prodrome of [[cough]], [[fever]], malaise, [[myalgia]]s, [[nausea/vomiting]]
**Foreign body sensation
*Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by<ref name="Meyer" />:
**Photohobia
**Lid swelling
**Chemosis
**Tearing
**Itching
**Photophobia
**[[Blurred vision]]
**Conjunctival injection
**Papillae of inf palpebral conjunctiva
**Papillae of inf palpebral conjunctiva
**Ipsilateral preauricular LAD
**Ipsilateral pre-auricular [[lymphadenopathy]]
 
*[[Slit lamp exam]] - diffuse, superficial keratitis but no corneal ulceration
==Diagnosis==
**Subepithelial infiltrates likely secondary to adenoviral antigens deposited in corneal stroma<ref name="Park">Park SJ, Jang YS, Koh TH, Kwon YA, Song SW. Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis. Korean Journal of Ophthalmology : KJO. 2011;25(6):443-446. doi:10.3341/kjo.2011.25.6.443.</ref>
*Slit Lamp
**These lesions usually regress within 3-6 weeks, but can last for months (and cause vision impairment if within the visual field)<ref name="Meyer" />
**Diffuse, superficial keratitis but no corneal ulceration


==Differential Diagnosis==
==Differential Diagnosis==
{{Conjunctivitis DDX}}
{{Conjunctivitis DDX}}


==Treatment==
==Evaluation==
*Artifical tears
*Clinical diagnosis
 
==Management==
*Artificial tears
*Cool compresses
*Cool compresses
*Cycloplegics if photophobia is severe
*[[Cycloplegic]]s if photophobia is severe
*Rigorous hand hygiene to prevent transmission


==Disposition==
==Disposition==
*Referral to ophthalmologist to confirm dx and decide if pt requires course of steroids
*Discharge with rapid ophtho follow-up.


==See Also==
==See Also==
*[[Conjunctivitis]]
*[[Conjunctivitis]]


==Source==
==References==
*Tintinalli
<References/>
*Mahmood, Narang. Diagnosis and management of acute red eye. Emerg Med Clin N Am 2008;26


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:ID]]
[[Category:ID]]

Revision as of 16:36, 5 October 2019

Background

  • Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis
  • Caused by adenovirus infection that is highly contagious and tends to occur in epidemics
    • Highly contagious and potentially vision-threatening[1]
    • Transmitted via contact with infectious fluids (commonly tear fluid) on hands, tissues, etc[1]
Subepithelial infiltrates in EKC

Clinical Features

  • Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.[1]
  • Can be preceded by prodrome of cough, fever, malaise, myalgias, nausea/vomiting
  • Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by[1]:
    • Lid swelling
    • Tearing
    • Itching
    • Photophobia
    • Blurred vision
    • Conjunctival injection
    • Papillae of inf palpebral conjunctiva
    • Ipsilateral pre-auricular lymphadenopathy
  • Slit lamp exam - diffuse, superficial keratitis but no corneal ulceration
    • Subepithelial infiltrates likely secondary to adenoviral antigens deposited in corneal stroma[2]
    • These lesions usually regress within 3-6 weeks, but can last for months (and cause vision impairment if within the visual field)[1]

Differential Diagnosis

Conjunctivitis Types

Evaluation

  • Clinical diagnosis

Management

  • Artificial tears
  • Cool compresses
  • Cycloplegics if photophobia is severe
  • Rigorous hand hygiene to prevent transmission

Disposition

  • Discharge with rapid ophtho follow-up.

See Also

References

  1. 1.0 1.1 1.2 1.3 1.4 Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C. Epidemic Keratoconjunctivitis: The Current Situation and Recommendations for Prevention and Treatment. Deutsches Ärzteblatt International. 2011;108(27):475-480. doi:10.3238/arztebl.2011.0475.
  2. Park SJ, Jang YS, Koh TH, Kwon YA, Song SW. Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis. Korean Journal of Ophthalmology : KJO. 2011;25(6):443-446. doi:10.3341/kjo.2011.25.6.443.