Keratoconjunctivitis
Background
- Defined as concurrent inflammation of both the cornea and conjunctiva.
Keratoconjunctivitis Types
- Atopic keratoconjunctivitis
- Caustic keratoconjunctivitis
- Secondary to chemical orbital exposure
- Epidemic keratoconjunctivitis
- Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
- Ultraviolet keratitis
- Secondary to UV light exposure
- Keratoconjunctivitis sicca
- Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma
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: herpes keratitis)
- Corneal abrasion
- Trauma/Ocular foreign body
- Chemical exposure
- Dacryocystitis
- Reactive arthritis
- Cluster headache
Evaluation
- Generally a clinical diagnosis
- Fluorescein test followed by tonometry:
- Fluorescein test if concerned for abrasions, 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
See Also
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.