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Epidemic Keratoconjunctivitis Treatment & Management

  • Author: Ahmed Bawazeer, MBChB, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Apr 03, 2015
 

Approach Considerations

Supportive management of epidemic keratoconjunctivitis includes the following:

  • Artificial tears
  • Cold compresses
  • Cycloplegic agents for severe photophobia
  • Topical corticosteroids
  • Topical agents that have antiviral activity

Depending on the severity of the signs and symptoms, patients should be followed up in several days to weeks.

Any patient on topical corticosteroids should be observed routinely to monitor for adverse effects, including elevated intraocular pressure and cataract formation.

Surgery is extremely rare and reserved for severe cases with cicatricial conjunctivitis secondary to symblepharon.

If surgery is necessary, it is mainly in the form of fornix reconstruction and entropion repair.

See the following for more information:

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Corticosteroid, Antiviral, and Immunosuppressive Therapies

Use topical corticosteroid therapy for severe membranous conjunctivitis or a marked reduction in visual acuity from late subepithelial opacities.

Taper this treatment slowly over a period of weeks to months to avoid recurrence of the corneal opacities.

Research has been ongoing for topical agents that have antiviral activity. Cidofovir has been shown to reduce the viral replication cycle and also to be effective as a prophylactic agent. Cidofovir may prove to be one of the most useful topical antiviral agents in the treatment of and prophylaxis for epidemic keratoconjunctivitis (EKC), which constitutes a professional hazard for all eye care professionals.[1, 2]

Topical 0.03% tacrolimus is a treatment option for subepithelial infiltrates.[5]

Povidone iodine can be used to reduce the duration of conjunctivitis.[6]

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Prevention of Epidemic Keratoconjunctivitis

To avoiding spreading epidemic keratoconjunctivitis (EKC), patients should be very careful not to touch others and not to share tissues, towels, or handkerchiefs and to wash their hands frequently as long as the eye is red.

Eye care professionals need to be extremely cautious regarding spreading of this infection to themselves or other patients. They should wash their hands immediately after examining any patient with a red eye. Anything the patient might have touched (especially the examination chair, slit lamp, and occluder) should be disinfected by office personnel immediately after the patient leaves the room.

Every effort needs to be made not to spread infections from one patient to another patient. A “red eye room” is a very good idea to try and limit potential spread. After any patient with a possible EKC infection is seen, the room needs to be disinfected. Physicians should wash their hands thoroughly after seeing any patient with a red eye. As a routine, they should wash their hands before seeing all patients.

In summary, prevention measures include the following:

  • Wash your hands before examining any patient.
  • Properly clean and sterilize ophthalmic instruments with hypochlorite solution.
  • Create a "red eye room" to separate red eye patients from others in the waiting room.
  • Patients who are infected should not share towels, pillows, washcloths, or other communal objects.
  • Personnel who are infected should be removed from duty for 2 weeks.
  • Warn other family members about the disease.
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Contributor Information and Disclosures
Author

Ahmed Bawazeer, MBChB, FRCSC  Professor and Chairman of Ophthalmology, Department of Ophthalmology, Division of Uveitis and Cornea, King Abdulaziz University, Saudi Arabia

Ahmed Bawazeer, MBChB, FRCSC is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

William G Hodge, MD, PhD, FRCSC Professor and Chair, Ophthalmologist in Chief, Ivey Eye Institute, Schulich School of Medicine and Dentistry, University of Western Ontario

William G Hodge, MD, PhD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, Quebec Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References
  1. Romanowski EG, Yates KA, Gordon YJ. Antiviral prophylaxis with twice daily topical cidofovir protects against challenge in the adenovirus type 5/New Zealand rabbit ocular model. Antiviral Res. 2001 Dec. 52(3):275-80. [Medline].

  2. Hillenkamp J, Reinhard T, Ross RS, Bohringer D, Cartsburg O, Roggendorf M, et al. The effects of cidofovir 1% with and without cyclosporin a 1% as a topical treatment of acute adenoviral keratoconjunctivitis: a controlled clinical pilot study. Ophthalmology. 2002 May. 109(5):845-50. [Medline].

  3. Yamazaki ES, Ferraz CA, Hazarbassanov RM, Allemann N, Campos M. Phototherapeutic keratectomy for the treatment of corneal opacities after epidemic keratoconjunctivitis. Am J Ophthalmol. 2011 Jan. 151(1):35-43.e1. [Medline].

  4. Sambursky R, Tauber S, Schirra F, Kozich K, Davidson R, Cohen EJ. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology. 2006 Oct. 113(10):1758-64. [Medline].

  5. Levinger E, Trivizki O, Shachar Y, Levinger S, Verssano D. Topical 0.03% tacrolimus for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol. 2014 May. 252(5):811-6. [Medline].

  6. Özen Tunay Z, Ozdemir O, Petricli IS. Povidone iodine in the treatment of adenoviral conjunctivitis in infants. Cutan Ocul Toxicol. 2015 Mar. 34(1):12-5. [Medline].

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Follicular conjunctivitis and subconjunctival hemorrhage.
Symblepharon secondary to epidemic keratoconjunctivitis.
 
 
 
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