Epidemic keratoconjunctivitis: Difference between revisions
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==Background== | ==Background== | ||
*Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis | *Form of [[viral conjunctivitis]] that causes keratitis in addition to conjunctivitis | ||
*Caused by adenovirus infection that is highly contagious and tends to occur in epidemics | *Caused by [[adenovirus]] infection that is highly contagious and tends to occur in epidemics | ||
**Highly | **Highly contagious and potentially vision-threatening<ref name="Meyer">Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C. Epidemic Keratoconjunctivitis: The Current Situation and Recommendations for Prevention and Treatment. Deutsches Ärzteblatt International. 2011;108(27):475-480. doi:10.3238/arztebl.2011.0475.</ref> | ||
**Transmitted via contact with infectious fluids (commonly tear fluid) on hands, tissues, etc<ref name="Meyer" /> | **Transmitted via contact with infectious fluids (commonly tear fluid) on hands, tissues, etc<ref name="Meyer" /> | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:EKC.png|thumb|Subepithelial infiltrates in epidemic keratoconjunctivitis]] | |||
*Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.<ref name="Meyer" /> | *Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.<ref name="Meyer" /> | ||
*Can be preceded by prodrome of cough, fever, malaise, | *Can be preceded by prodrome of [[cough]], [[fever]], malaise, [[myalgia]]s, [[nausea/vomiting]] | ||
*Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by<ref name="Meyer" />: | *Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by<ref name="Meyer" />: | ||
**Lid swelling | **Lid swelling | ||
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**Itching | **Itching | ||
**Photophobia | **Photophobia | ||
**Blurred vision | **[[Blurred vision]] | ||
**Conjunctival injection | **Conjunctival injection | ||
**Papillae of inf palpebral conjunctiva | **Papillae of inf palpebral conjunctiva | ||
**Ipsilateral pre-auricular lymphadenopathy | **Ipsilateral pre-auricular [[lymphadenopathy]] | ||
*Slit lamp exam - diffuse, superficial keratitis but no corneal ulceration | *[[Slit lamp exam]] - diffuse, superficial keratitis but no corneal ulceration | ||
**Subepithelial infiltrates likely secondary to adenoviral antigens deposited in corneal stroma<ref name="Park">Park SJ, Jang YS, Koh TH, Kwon YA, Song SW. Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis. Korean Journal of Ophthalmology : KJO. 2011;25(6):443-446. doi:10.3341/kjo.2011.25.6.443.</ref> | **Subepithelial infiltrates likely secondary to adenoviral antigens deposited in corneal stroma<ref name="Park">Park SJ, Jang YS, Koh TH, Kwon YA, Song SW. Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis. Korean Journal of Ophthalmology : KJO. 2011;25(6):443-446. doi:10.3341/kjo.2011.25.6.443.</ref> | ||
**These lesions usually regress within 3-6 weeks, but can last for months (and cause vision impairment if within the visual field)<ref name="Meyer" /> | **These lesions usually regress within 3-6 weeks, but can last for months (and cause vision impairment if within the visual field)<ref name="Meyer" /> | ||
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{{Conjunctivitis DDX}} | {{Conjunctivitis DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
==Management== | ==Management== | ||
* | *Artificial tears | ||
*Cool compresses | *Cool compresses | ||
* | *[[Cycloplegic]]s if photophobia is severe | ||
*Rigorous hand hygiene to prevent transmission | *Rigorous hand hygiene to prevent transmission | ||
Latest revision as of 19:09, 26 September 2020
Background
- Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis
- Caused by adenovirus infection that is highly contagious and tends to occur in epidemics
Clinical Features
- Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.[1]
- Can be preceded by prodrome of cough, fever, malaise, myalgias, nausea/vomiting
- Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by[1]:
- Lid swelling
- Tearing
- Itching
- Photophobia
- Blurred vision
- Conjunctival injection
- Papillae of inf palpebral conjunctiva
- Ipsilateral pre-auricular lymphadenopathy
- Slit lamp exam - diffuse, superficial keratitis but no corneal ulceration
Differential Diagnosis
Conjunctivitis Types
Evaluation
- Clinical diagnosis
Management
- Artificial tears
- Cool compresses
- Cycloplegics if photophobia is severe
- Rigorous hand hygiene to prevent transmission
Disposition
- Discharge with rapid ophtho follow-up.
See Also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C. Epidemic Keratoconjunctivitis: The Current Situation and Recommendations for Prevention and Treatment. Deutsches Ärzteblatt International. 2011;108(27):475-480. doi:10.3238/arztebl.2011.0475.
- ↑ Park SJ, Jang YS, Koh TH, Kwon YA, Song SW. Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis. Korean Journal of Ophthalmology : KJO. 2011;25(6):443-446. doi:10.3341/kjo.2011.25.6.443.