Epidemic keratoconjunctivitis

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 contageous 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

  • Artifical 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.