Keratoconjunctivitis, Epidemic Emedicine Home
Synonyms: Pink Eye

Authored by Ahmed Bawazeer, MBChB, FRCS(C), Fellow, Department of Ophthalmology, Division of Uveitis and Cornea, University of Ottawa Eye Institute

Coauthored by William Hodge, MD, Assistant Professor, Department of Ophthalmology, University of Ottawa Eye Institute

Edited by Anastasios J Kanellopoulos, MD, Assistant Director Residency Training, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University Medical; Donald S Fong, MD, MPH, Assistant Clinical Professor, Department of Ophthalmology, UCLA School of Medicine; Christopher J Rapuano, MD, Co-Chairman, Refractive Surgery Department, Associate Professor, Consulting Surgeon, Cornea Service, Wills Eye Hospital, Jefferson Medical College; Lance L Brown, OD, MD, Consulting Staff, Department of Ophthalmology, University of Kansas Medical Center; and Hampton Roy Sr, MD, Clinical Associate Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Author's Email: Ahmed Bawazeer, MBChB, FRCS(C)Topic Last Updated:
Editor's Email:Anastasios J Kanellopoulos, MD05/21/2000 12:06:02

INTRODUCTION

Background:

Pathophysiology:

Frequency:

Mortality/Morbidity: EKC is a self-limiting disease. It tends to resolve spontaneously within 1-3 weeks without any complications.

Race: N/A

Sex: No gender predilection

Age: The infection is more common in adults, but all age groups can be affected.

CLINICAL

History: This eye infection may be preceded by flu-like symptoms, including fever, malaise, respiratory symptoms, nausea, vomiting, diarrhea and myalgia.

Physical:

Causes: N/A

DIFFERENTIALS

Trachoma


Other Problems to be Considered:

Differential diagnosis of acute follicular conjunctivitis.

Epidemic Keratoconjunctivitis

Pharyngoconjunctival fever

Acute Trachoma

Acute inclusion conjunctivitis

Primary Herpes simplex conjunctivitis

Acute hemorrhagic conjunctivitis

Infectious mononucleosis

Neonatal inclusion conjunctivitis


Differential diagnosis of Subepithelial corneal opacities.

Epidemic Keratoconjunctivitis

Herpes simplex infection

Herpes Zoster infection

Infectious Mononucleosis

Epstein-Barr virus infection

Dimmer's Keratitis

Brucellosis

Onchocerciasis

WORKUP

Lab Studies:

Imaging Studies:

Other Tests:

Procedures:

Histologic Findings: N/A

TREATMENT

Medical Care: Supportive management includes

Surgical Care:

Consultations: "N/A"

Diet: "N/A"

Activity: "N/A"

MEDICATION

Topical corticosteroids are a group of anti-inflammatory agents, it causes inhibition of inflammatory response by potentiation of epinephrine vasoconstriction , stabilization of lysosomal membranes, decrease macrophage movement, prevention of kinin release, interfere with lymphocytes and neutrophil function, and inhibition of prostaglandin synthesis througth inhibition of phospholipase enzyme.

Drug Category: Topical Corticosteroids.

Drug NameDexamethasone.
Adult DoseDepend on the severity of the inflammation, dose can range between 1 gtt q1-6h and should be tapered slowly over few days to weeks.
Pediatric DoseSame regimen as in adults.
ContraindicationsEpithelial HSV keratitis. Varicella. Steroid responders (Glaucoma). Acute viral keratitis. Suspected fungal keratitis. Mycobacterial infection. Hypersensitivity to any component of the formulation including sulfites. Acute purulent infection.
InteractionsNo drug interaction reported.
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsCan cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use.
Drug NameFluorometholone.
Adult DoseDepend on the severity of the inflammation, dose can range between 1 gtt q1-6h and should be tapered slowly over few days to weeks.
Pediatric DoseSame regimen as in adults.
ContraindicationsEpithelial HSV keratitis. Varicella. Steroid responders (Glaucoma). Acute viral keratitis. Suspected fungal keratitis. Mycobacterial infection. Hypersensitivity to any component of the formulation including sulfites. Acute purulent infection.
InteractionsNo drug interaction reported.
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsCan cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use.
Drug NamePrednisolone.
Adult DoseDepend on the severity of the inflammation, dose can range between 1 gtt q1-6h and should be tapered slowly over few days to weeks.
Pediatric DoseSame regimen as in adults.
ContraindicationsEpithelial HSV keratitis. Varicella. Steroid responders (Glaucoma). Acute viral keratitis. Suspected fungal keratitis. Mycobacterial infection. Hypersensitivity to any component of the formulation including sulfites. Acute purulent infection.
InteractionsNo drug interaction reported.
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsCan cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use.
Drug NameRimexolone 1% ( Vexol )
Adult DoseDepend on the severity of the inflammation, dose can range between 1 gtt q1-6h and should be tapered slowly over few days to weeks.
Pediatric DoseSame regimen as in adults.
ContraindicationsEpithelial HSV keratitis. Varicella. Steroid responders (Glaucoma). Acute viral keratitis. Suspected fungal keratitis. Mycobacterial infection. Hypersensitivity to any component of the formulation. Acute purulent infection.
InteractionsNo drug interaction reported.
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsCan cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use.

FOLLOW-UP

Further Inpatient Care:

Further Outpatient Care:

In/Out Patient Meds:

Transfer:

Deterrence/Prevention:

Complications:

Prognosis:

Patient Education:

MISCELLANEOUS

Medical/Legal Pitfalls:

Special Concerns:

TEST QUESTIONS

CME Question 1: Which is NOT consistent with an adenoviral eye infection?


A: Erythematous conjunctivitis ("pink eye")
B: Preauricular adenopathy
C: Subepithelial cornea opacities
D: Purulent conjunctivitis
E: Normal visual acuity

The correct answer is D: A purulent conjunctivitis is more consistent with a bacterial infection not a viral infection.

CME Question 2: Which of the following scenarios best depicts an ocular adenovirus infection?


A: Unilateral infection
B: Bilateral infection, equally symmetric
C: Bilateral infection with the worse eye being the first infected eye
D: Bilateral infection with the worse eye being the second infected eye
E: Bilateral infection but no typical presentation

The correct answer is C: The first involved eye is typically red and irritated with watery discharge. Usually days later, the second eye becomes involved but less intensely than the first eye.

Pearl Question 1 : What are the indications for topical corticosteroids in epidemic keratoconjunctivitis (EKC)?

The correct answer is : Severe reduction in vision secondary to corneal opacities and severe membranous conjunctivitis

Pearl Question 2 : What is the differential diagnosis of membranous conjunctivitis?

The correct answer is : Adenoviral conjunctivitis, herpes simplex conjunctivitis, chemical burns, severe bacterial conjunctivitis and Stevens-Johnson syndrome

Pearl Question 3 : What is the most common cause of epidemic keratoconjunctivitis (EKC)?

The correct answer is : Adenovirus serotype 8, 19 and 37

Pearl Question 4 : What is the indication for surgery in epidemic keratoconjunctivitis (EKC)?

The correct answer is : Symblepharon and Entropion

PICTURES

Caption: Picture 1. Follicular conjunctivitis and subconjunctival hemorrhage

Click to see larger picture

Picture Type: Photo

Caption: Picture 2. Symblepharon secondary to epidemic keratoconjunctivitis

Click to see larger picture

Picture Type: Photo

BIBLIOGRAPHY

NOTE:
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this textbook have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this text do not warrant the information in this text is accurate or complete, nor are they responsible for omissions or errors in the text or for the results of using this information. The reader should confirm the information in this text from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER

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