Keratoconjunctivitis

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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.