eMedicine Specialties > Ophthalmology > Conjunctiva

Keratoconjunctivitis, Epidemic: Treatment & Medication

Author: Ahmed Bawazeer, MBChB, FRCS(C), Department of Ophthalmology, Division of Uveitis and Cornea, Assistant Professor, King Abdulaziz University, Saudi Arabia
Coauthor(s): William Hodge, MD, Fellowship Director, Assistant Professor, Department of Ophthalmology, University of Ottawa Eye Institute, Canada
Contributor Information and Disclosures

Updated: Jan 7, 2008

Treatment

Medical Care

Supportive management includes the following:

  • Artificial tears
  • Cold compresses
  • Cycloplegic agents for severe photophobia
  • Topical corticosteroids
    • Use for severe membranous conjunctivitis or marked reduction in visual acuity from late subepithelial opacities.
    • Taper 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 and prophylaxis of EKC epidemics that constitute a professional hazard for all eye care professionals.1

Surgical Care

  • 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.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Corticosteroids

Topical corticosteroids are a group of anti-inflammatory agents that cause 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 through inhibition of phospholipase enzyme.


Dexamethasone (Ocu-Dex)

For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Adult

1 gtt q1-6h depending on severity of inflammation; once satisfactory response achieved, taper dose slowly over few d to wk

Pediatric

Administer as in adults

Documented hypersensitivity; active bacterial, viral, or fungal infection

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may increase hazard of secondary ocular infection; suspect fungal invasion in any persistent corneal ulceration where a corticosteroid has been used or is in use (obtain fungal cultures when appropriate)


Fluorometholone (FML, Flarex, FML Forte)

Suppresses migration of polymorphonuclear leukocytes and reverses capillary permeability.

Adult

1 gtt q1-6h depending on severity of inflammation; once satisfactory response achieved, taper dose slowly over few d to wk

Pediatric

Administer as in adults

Documented hypersensitivity; herpes simplex, keratitis, viral and fungal diseases of the ocular structure

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may result in elevated intraocular pressure or glaucoma


Prednisolone (Pred Forte)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Adult

1 gtt q1-6h depending on severity of inflammation; once satisfactory response achieved, taper dose slowly over few d to wk

Pediatric

Administer as in adults

Documented hypersensitivity; viral, fungal, or tubercular infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hypertension; known to cause cataract formation with long-term use; suspect fungal invasion in any persistent corneal ulceration where a corticosteroid has been used or is in use (obtain fungal cultures when appropriate)


Rimexolone 1% (Vexol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Adult

1 gtt q1-6h depending on severity of inflammation; once satisfactory response achieved, taper dose slowly over few d to wk

Pediatric

Administer as in adults

Documented hypersensitivity; viral, fungal, or bacterial ocular infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in corneal or scleral perforation, and posterior subcapsular cataracts

More on Keratoconjunctivitis, Epidemic

Overview: Keratoconjunctivitis, Epidemic
Differential Diagnoses & Workup: Keratoconjunctivitis, Epidemic
Treatment & Medication: Keratoconjunctivitis, Epidemic
Follow-up: Keratoconjunctivitis, Epidemic
Multimedia: Keratoconjunctivitis, Epidemic
References
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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. Dec 2001;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. May 2002;109(5):845-50. [Medline].

  3. Kaufman HE, Barron BA, McDonald MB. Nonherpetic viral infections. Cornea. 1998;303-6.

  4. Krashmer JH, Mannis MJ, Holland E. Conjunctivitis: an overview and classification, viral conjunctivitis. Cornea. 2005;601-612, 629-634.

  5. Leibowitz HM, Waring GO. Superficial punctate keratopathy. In: Clinical Disorders: Clinical Diagnosis and Management. 1998:445-7.

  6. Romanowski EG, Gordon YJ, Araullo-Cruz T, Yates KA, Kinchington PR. The antiviral resistance and replication of cidofovir-resistant adenovirus variants in the New Zealand White rabbit ocular model. Invest Ophthalmol Vis Sci. Jul 2001;42(8):1812-5. [Medline].

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

  8. Smolin G, Thoft RA. Viral keratitis and conjunctivitis. In: Cornea: Scientific Foundations and Clinical Practice. 2005:359-364.

  9. Sutphin JE, et al. Viral infections. In: Section 8. AAO Basic and Clinical Science Course. 2006:157-160.

  10. Duane's Clinical Ophthalmology on CD-ROM [book on CD-ROM]. 2006. Tasman W, Jaeger EA.

  11. Yanoff M, Duker JS. Disorders of the conjunctiva and limbus. Ophthalmology. 2004;chapter 55:399-401.

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Further Reading

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Keywords

epidemic keratoconjunctivitis, EKC, pink eye, adenoviral conjunctivitis

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Contributor Information and Disclosures

Author

Ahmed Bawazeer, MBChB, FRCS(C), Department of Ophthalmology, Division of Uveitis and Cornea, Assistant Professor, King Abdulaziz University, Saudi Arabia
Ahmed Bawazeer, MBChB, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

William Hodge, MD, Fellowship Director, Assistant Professor, Department of Ophthalmology, University of Ottawa Eye Institute, Canada
William Hodge, MD is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Anastasios J Kanellopoulos, MD, Assistant Program Director, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University
Anastasios J Kanellopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Eye Bank Association of America, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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