Epidemic keratoconjunctivitis is an infection of the eye caused by adenoviruses. The name of the condition stems from the fact that it frequently causes outbreaks, due to its ability to spread from person to person. Redness of the eye, as well as photophobia, blurred vision, ocular discharge, and in some cases, constitutional symptoms such as fever and lymphadenopathy, are described as main complaints. A detailed clinical and microbiological workup is necessary in order to make the diagnosis.
Epidemic keratoconjunctivitis (EK), defined as a highly contagious infection of the eye surface (the conjunctiva and associated tissues), is caused by double-stranded DNA adenoviruses  . More than 50 adenoviruses have been described in the literature, but serotypes 8, 19, and 37 are established as main pathogens of EK   . Because of their resistance to the majority of disinfectants and heat tolerance (they are able to survive at room temperature), adenoviruses are potent causes of epidemic infections and outbreaks, one of them being epidemic keratoconjunctivitis . Humans are the only known reservoir of adenoviruses, and person-to-person transmission is achieved through direct or close contact with individuals (mainly tear fluids) who are actively shedding the virus when exhibiting signs and symptoms, while some studies have established that individuals remain infectious even a few weeks after resolution of symptoms   . After an incubation period that lasts for about 2-12 days, the clinical presentation is distinguished by a severe inflammatory process that leads to redness of the eye accompanied by irritation, excessive tearing and discharge that causes blurred vision, as well as photophobia and a sensation of foreign body presence    . EK initially affects only one eye, but it may spread to the other eye as well, although with a much milder presentation . In some patients, generalized symptoms in the form of fever, headaches, proximal lymphadenopathy appear (preauricular lymph nodes are most often involved), but the prognosis is generally self-limiting   . EK is predominantly reported in crowded areas (eg. schools, health-care institutions, but also pools due to poorly chlorinated water that contains adenovirus particles) and has no seasonal predilection  .
Entire Body System
Redness of the eye, as well as photophobia, blurred vision, ocular discharge, and in some cases, constitutional symptoms such as fever and lymphadenopathy, are described as main complaints. [symptoma.com]
EKC patients may complain about influenza-like symptoms, including fever, malaise, respiratory symptoms, nausea, vomiting, diarrhea, and myalgia. [genome.jp]
[…] blurred vision and lymphadenopathy by the ear nearest the affected eye. It is often associated with a sore throat and stuffy and runny nose, mainly in adults. A type of adenoviral keratoconjunctivitis in very young children can present with a high fever [en.wikipedia.org]
Family of adenoviruses contain different serotypes that can also cause pharyngoconjunctival fever, non-specific sporadic follicular conjunctivitis and chronic papillary conjunctivitis. [aimu.us]
Symptoms: Foreign body sensation, photophobia, conjunctival hyperemic, eyelid stuck together in the morning, eyelid edema and sero-fibrinous discharge Ocular symptoms commonly preceded by systemic symptoms of fever, sore throat and sometimes gastrointestinal [dro.hs.columbia.edu]
- Conjunctival Injection
Case Presentation A 67-year-old man was referred to Oculoplastics after suffering from conjunctival injection and chemosis in the right eye for 4 days. [karger.com]
RESULTS: After a mean of 1.8 ± 0.7 days of oral steroid treatment, eyelid edema, corneal damage, conjunctival injection, follicles, and chemosis improved in all patients. [ncbi.nlm.nih.gov]
The hazard for resolution of lid edema (HR 0.41, adj.p=0.009), bulbar conjunctival injection (HR 0.55, adj.p=0.009), abnormal tear meniscus (HR 0.56, p=0.007), tearing (HR 0.54, adj p [digital.lib.washington.edu]
Note crusting, lid swelling, and conjunctival injection. Diagnosis Diagnosis of EKC is typically made on clinical presentation. [aao.org]
The right eye had a 1+ conjunctival injection compared with her left eye’s 3+ conjunctival injections of multiple petechial hemorrhages. There was a bilateral inferior palpebral folliculitis. Visual acuity measured 6/6 OD and 6/7.5 OS. [webmedcentral.com]
- Excessive Tearing
After an incubation period that lasts for about 2-12 days, the clinical presentation is distinguished by a severe inflammatory process that leads to redness of the eye accompanied by irritation, excessive tearing and discharge that causes blurred vision [symptoma.com]
tearing Follicular reaction Foreign body sensation This disorder is caused by a small virus and therefore has no specific treatment. [flei.com]
Other classic features are burning, foreign body sensation, excessive tearing, and photophobia. [amboss.com]
Presentation Often, EKC initially manifests as a flu-like syndrome consisting of fever, malaise, and myalgias followed by the appearance of ocular signs and symptoms, including a red eye, eyelid edema, excessive tearing, irritation, foreign body sensation [aao.org]
During the first five days of active disease there is pain/discomfort, redness of the white part of the eye and excessive tearing (watery/serous discharge from the eyes). [mastereyeassociates.com]
- Unilateral Red Eye
Herpes Simplex Keratitis Signs and Symptoms The keratitis caused by the herpes simplex virus (HSV) typically presents as a unilateral "red eye" with a variable degree of pain or ocular irritation. [medicalstudy.blogspot.com]
The differential diagnosis of eye redness and conjunctivitis is quite broad, but despite the fact that adenoviruses are one of the most important causes of this clinical entity, a thorough clinical investigation is recommended in order to raise suspicion toward an adenovirus infection . Key information may be obtained during history taking when the physician should inquire whether similar symptoms have been reported by other individuals who were in close contact with the patient (eg. classmates, coworkers). Physical examination is an equally important part of the workup, during which eyelid and periorbital edema are observed, in addition to conjunctival hyperemia   . A slit-lamp examination performed by a skilled ophthalmologist can further support the diagnosis by detecting conjunctival swelling, hyperemia, and pseudomembrane formation in some cases . When sufficient clinical criteria are obtained, microbiological studies need to be employed. Viral cultures carry a very successful rate of detecting viruses from patient samples, but their rather long turnaround times often requires the use of alternative methods, such as antigen detection through serology and indirect immunofluorescence . But the low specificity and sensitivity of these studies (together with cultures) have placed them in an inferior position compared to newer and faster, but equally sensitive and specific methods . Polymerase chain reaction (PCR), a molecular test that can yield conclusive results within a day, is widely recommended as the main method of diagnosing adenoviruses, although its cost still reduces its overall use in general practice    .
Patients were randomly assigned to treatment with trifluridine, dexamethasone, or artificial tears, and examined in a double-masked fashion. There was no significant difference between the results of the three treatments. [ncbi.nlm.nih.gov]
[…] as a result of the severity of their symptoms. 7 The treatment of EKC often includes palliative treatment, such as cool compresses and artificial tears. 6 In various instances, EKC treatment has also consisted of topical antibiotics, topical nonsteroidal [journalofoptometry.org]
There is currently no effective and clinically applicable topical antiviral agent for the treatment of the acute phase of AKC. [en.wikipedia.org]
The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.com]
In some patients, generalized symptoms in the form of fever, headaches, proximal lymphadenopathy appear (preauricular lymph nodes are most often involved), but the prognosis is generally self-limiting. [symptoma.com]
[…] herpes simplex virus (HSV), varicella-zoster virus ( VZV ), picornavirus, molluscum contagiosum, HIV (highly contagious) Clinical features See “Clinical features” above Epidemic keratoconjunctivitis Herpes simplex conjunctivitis Diagnosis Treatment Prognosis [amboss.com]
[…] rubbing the eyes (this may be difficult when the affected individuals are very young children) Stop or restrain yourself from smoking tobacco, or drinking alcohol The condition is seasonal/periodic, and individuals may chronically contract EKC What is the Prognosis [dovemed.com]
In general, the prognosis for visual acuity in patients with dry eye disease is good. Patients with SS or prolonged untreated dry eye represent a subgroup with a worse prognosis, requiring a longer course of treatment. [emedicine.medscape.com]
However, the nucleotide sequence of the fiber gene was identical to that of the HAdV-8 prototype strain. 22 We propose that this virus is a new hexon-chimeric intermediate HAdV-22,37/H8, and may be an etiological agent of EKC. [ncbi.nlm.nih.gov]
Methods: Isolation of the etiologic agent was achieved using cultured African green monkey kidney epithelial cells (VERO). [molvis.org]
Further genetic analysis of serologically classified HAdV-D isolates may provide insights into the epidemiology of EKC. [ncbi.nlm.nih.gov]
Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology × [cambridge.org]
(See Etiology and Epidemiology.) [emedicine.medscape.com]
An outbreak within our institute caused by Ad8 from a disseminated source was characterized by molecular and epidemiological studies. [molvis.org]
HAdVs are known for their strong host species specificity that limits studying HAdV virulence and pathophysiology in animal models. [ncbi.nlm.nih.gov]
Despite this difference, VKC and GPC are pathophysiologically similar. [medicalstudy.blogspot.com]
Usually chronic progression ( ∼ 10–30 years from symptom onset to end stage) with periods of remission and exacerbation Individual progression on or off treatment is unpredictable (→ long term follow-up is vital) Epidemiology : common in young adults Pathophysiology [amboss.com]
In this article, well explain the pathophysiology of viral eye infection, suggest how to nail the diagnosis, and provide a step-by-step explanation of this highly effective, inexpensive, patient-friendly silver bullet EKC treatment. [reviewofoptometry.com]
Pathophysiology A genetic predisposition in SS-associated dry eye disease exists, as is evidenced by the high prevalence of human leukocyte antigen B8 (HLA-B8) haplotype in these patients. [emedicine.medscape.com]
Thus, preventive strategies undertaken by clinicians are paramount in reducing infections and their public health consequences. [aao.org]
[…] and Prevention, Rikaze City, Tibet Autonomous Region, People's Republic of China. 8 Xi'an Center for Disease Control and Prevention, Xi'an City, Shaanxi Province, People's Republic of China. [ncbi.nlm.nih.gov]
Duration 7-10 days, can be longer Causes Adenoviruses, commonly types 8 and 37 Diagnostic method Visualisation, viral culture (with immunofluorescence staining), PCR Differential diagnosis Herpes simplex type I, acanthamoeba, fungal infection Prevention [en.wikipedia.org]
- Kimura R, Migita H, Kadonosono K, Uchio E. Is it possible to detect the presence of adenovirus in conjunctiva before the onset of conjunctivitis? Acta Ophthalmol. 2009 Feb;87(1):44-47.
- Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C. Epidemic Keratoconjunctivitis: The Current Situation and Recommendations for Prevention and Treatment. Dtsch Arztebl Int. 2011;108(27):475-480.
- Viney KA, Kehoe PJ, Doyle B, et al. An outbreak of epidemic keratoconjunctivitis in a regional ophthalmology clinic in New South Wales. Epidemiol Infect. 2008;136(9):1197-1206.
- Lee Y-C, Chen N, Huang I-T, et al. Human adenovirus type 8 epidemic keratoconjunctivitis with large corneal epithelial full-layer detachment: an endemic outbreak with uncommon manifestations. Clin Ophthalmol. 2015;9:953-957.
- Pihos MA. Epidemic keratoconjunctivitis: A review of current concepts in management. J Optom. 2013;6(2):69-74.
- Melendez CP, Florentino MM, Martinez IL, Mejia Lopez H. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents. Mol Vis. 2009;15:557-562.
- Adhikary AK, Numaga J, Kaburaki T, et al. Rapid detection and typing of oculopathogenic strain of subgenus D adenoviruses by fiber-based PCR and restriction enzyme analysis. Invest Ophthalmol Vis Sci. 2001;42:2010–2015.
- Elnifro EM, Cooper RJ, Klapper PE, Yeo AC, Tullo AB. Multiplex polymerase chain reaction for diagnosis of viral and chlamydial keratoconjunctivitis. Invest Ophthalmol Vis Sci. 2000;41:1818–22