Adenoviral Conjunctivitis


Patients often complain of burning or gritty foreign body sensation. There is usually a watery, mucoid discharge—morning crusting is a common complaint. The lids may become red and edematous (swollen). Classically, preauricular lymphadenopathy (inflamed lymph node) can be palpated.
Symptoms usually begin and predominate in one eye, and within a few days, have spread to the contralateral eye. A history of antecedent upper respiratory tract infection or close contact with someone with a “red eye” is common.
When adenoviral eye infections further involve the cornea, the term “epidemic keratoconjunctivitis” (EKC) is used. Patients with EKC may have photophobia (intolerance to light) and reduced vision long after resolution of the acute infection.
Pharyngoconjunctival fever describes adenoviral conjunctivitis with the additional systemic symptoms of fever, sore throat, and headache. Corneal infiltrates are very rare.
Adenovirus infection is quite contagious, as the virus is transmitted readily in respiratory or ocular secretions, contaminated fomites (including eye droppers and mascara bottles), and even contaminated swimming pools. Frequent handwashing is recommended and care must be taken to avoid contamination to others through towels, make-up, instruments, or other fomites.
Please wash your hands frequently and sanitize your work station.
Notify immediately if you see a patient with the described signs.

occurs equally in men and women
no racial predilection highly contagious—outbreaks can sometimes be traced to infected individuals or locations

SYMPTOMS
“Red eye” noted by the patient
watery during the day and crusting noted in the mornings
swollen lids
patient noticed in one eye first, perhaps with later spread to the opposite eye in pharyngoconjunctival fever—sore throat, fever, and headache may be present

For Physicians: SIGNS
follicular conjunctivitis (especially on the inferior palpepral conjunctiva)
watery, mucoid discharge
crusting may be evident on the lashes
edematous lids
palpable preauricular lymphadenopathy
pinpoint suconjunctival hemorrhage in EKC, pseudomembranes and subepithelial (stromal) infiltrates can be seen.

For Physicians: TREATMENT : usually supportive
cool compress and artificial tears for comfort several times a day
prevent contagious spread (including washing sheets and pillowcases, handwashing, and cleaning of instrumentation in the physician’s office). Temporary leave of absence should be considered for patients who work with the public who have active infection.
NO antibiotic or antiviral drops are routinely used. In cases where bacterial co- or super- infection is suspect, antibiotic drops may be indicated. There are no antiviral drugs approved for adenoviral conjunctivitis in EKC only: pseudomembranes should be manually peeled every 2-3days. Topical corticosteroids may be needed (i.e. prednisolone acetate, 0.125%, q.i.d.) to prevent scarring.

Hoping no one gets infected...
Dr. A.