Keratoconjunctivitis, Epidemic |
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: |
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Editor's Email: | Anastasios J Kanellopoulos, MD | 05/21/2000 12:06:02 |
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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.
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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
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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
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Lab Studies:
Imaging Studies:
Other Tests:
Procedures:
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Medical Care: Supportive management includes
Surgical Care:
Consultations: "N/A"
Diet: "N/A"
Activity: "N/A"
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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 Name | Dexamethasone. |
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Adult Dose | Depend 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 Dose | Same regimen as in adults. |
Contraindications | Epithelial 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. |
Interactions | No drug interaction reported. |
Pregnancy | C - Safety for use during pregnancy has not been established. |
Precautions | Can cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use. |
Drug Name | Fluorometholone. |
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Adult Dose | Depend 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 Dose | Same regimen as in adults. |
Contraindications | Epithelial 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. |
Interactions | No drug interaction reported. |
Pregnancy | C - Safety for use during pregnancy has not been established. |
Precautions | Can cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use. |
Drug Name | Prednisolone. |
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Adult Dose | Depend 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 Dose | Same regimen as in adults. |
Contraindications | Epithelial 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. |
Interactions | No drug interaction reported. |
Pregnancy | C - Safety for use during pregnancy has not been established. |
Precautions | Can cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use. |
Drug Name | Rimexolone 1% ( Vexol ) |
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Adult Dose | Depend 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 Dose | Same regimen as in adults. |
Contraindications | Epithelial HSV keratitis. Varicella. Steroid responders (Glaucoma). Acute viral keratitis. Suspected fungal keratitis. Mycobacterial infection. Hypersensitivity to any component of the formulation. Acute purulent infection. |
Interactions | No drug interaction reported. |
Pregnancy | C - Safety for use during pregnancy has not been established. |
Precautions | Can cause an increase in intraocular pressure, use with caution in pateints with Glaucoma. Can cause cataract in chronic use. |
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Further Inpatient Care:
Further Outpatient Care:
In/Out Patient Meds:
Transfer:
Deterrence/Prevention:
Complications:
Prognosis:
Patient Education:
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Medical/Legal Pitfalls:
Special Concerns:
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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
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Caption: Picture 1. Follicular conjunctivitis and subconjunctival hemorrhage
Picture Type: Photo
Caption: Picture 2. Symblepharon secondary to epidemic keratoconjunctivitis
Picture Type: Photo
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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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