Adenoviral keratoconjunctivitis

Adenoviral keratoconjunctivitis, also known as epidemic keratoconjunctivitis, is a contagious eye infection, a type of adenovirus disease caused by adenoviruses.^[1] It typically presents as a conjunctivitis with a sudden onset of a painful red eye, watery discharge and feeling that something is in the eye.^[3] Photophobia develops with blurred vision and lymphadenopathy by the ear nearest the affected eye.^[2] It is often associated with a sore throat and stuffy and runny nose, mainly in adults.^[3] A type of adenoviral keratoconjunctivitis in very young children can present with a high fever, sore throat, ear infection, vomiting and diarrhea.^[3]

Keratoconjunctivitis
Other names	Keratoconjunctivitis epidemica
Adenoviral Keratoconjunctivitis
Specialty	Ophthalmology, infectious diseases
Symptoms	Red eye, discomfort/irritation, sensitivity to light, watering, blurred vision, discharge[1]
Complications	Corneal scarring[2]
Usual onset	Sudden in an adult[3]
Duration	7–10 days, can be longer[3]
Causes	Adenoviruses, commonly types 8 and 37[3]
Diagnostic method	Visualisation, viral culture (with immunofluorescence staining), PCR (to detect viral DNA)[3]
Differential diagnosis	Herpes simplex type I, acanthamoeba, fungal infection[4]
Prevention	Hand washing[3]
Treatment	Cold compress, artificial tears[2]
Frequency	Epidemics, common, adults>children[2]

It is commonly caused by types 8 and 37 adenoviruses, spread by contaminated eye examination instruments and eye solutions, touching eyes by infected people, from inadequately chlorinated swimming pools, or other contaminated objects.^[3] The incubation period is around five to 10 days.^[3]

Usually, the condition is better after a week to 10 days without treatment.^[3] Cold compresses and artificial tears may help.^[2] Corneal scarring occurs in up to half of cases and the blurred vision may continue for a long time in some people.^[2] The virus may remain in the eye for 2–3 years after recovering.^[3]

It is a common cause of a red eye and tends to occur in large numbers of people at the same time.^[2] Adults tend to be affected more frequently than children.^[3]

Signs and symptoms

It typically presents as a conjunctivitis with a sudden onset of red eye, watery discharge and feeling that something is in the eye.^[3] Photophobia develops with blurred vision and lymphadenopathy by the ear nearest the affected eye.^[2] It is typically associated with a pharyngitis and rhinitis, mainly in adults.^[3] A type of adenoviral keratoconjunctivitis in very young children can present with a high fever, sore throat, ear infection, vomiting and diarrhea.^[3]

Diagnosis

The diagnosis of Adenoviral keratoconjunctivitis is done using cell culture (with immunofluorescence staining) and PCR.^[4]

Differential diagnosis

It may appear similar to herpes simplex type I, Acanthamoeba, and fungal infection.^[4]

Prevention

Adequate infection control measures should be followed as prevention and to reduce epidemic AKC outbreaks.^[5]

Treatment

Treatment of adenoviral conjunctivitis is supportive. Lubricating eye drops, cold compresses. Antihistamines in cases of severe itching and (rarely) antibiotics to prevent secondary infections. There is clinical evidence that topical ganciclovir is effective against at least Adenovirus serotype 8, thus compelling many clinicians to prescribe this agent off-label for compelling cases of epidemic keratoconjunctivitis (EKC), particularly when corneal lesions are noted.^[6]

Epidemiology

Globally it is the commonest cause of a red eye and tends to occur in large numbers of people at the same time.^[2] Adults tend to be affected more frequently than children.^[3]