Adenoviral Keratoconjunctivitis
Adenoviral keratoconjunctivitis is inflammation of the mucous membrane of the eye (conjunctiva) and the cornea caused by adenoviral infection.
The virus is usually characterized by contact transmission, when shaking hands, touching contaminated objects (those that came into contact with an infected person), etc. Infection can also develop during diagnostic tests where probes touch patients’ eyes, such as tonometry (checking intraocular pressure) or ultrasonography (visualization of ocular structures).
As the adenovirus favors the upper respiratory tract, airborne transmission is also a possibility (when microscopic droplets produced by sneezing and coughing end up in the eye).
Adenoviral conjunctivitis can also occur as a complication of acute respiratory infection of adenoviral origin. In such cases, ocular signs are preceded by hyperthermia (fever) and enlargement of submandibular and parotid lymph nodes.
The incubation period in case of contact transmission is 5–7 days. The virus spreads quickly and is highly contagious, which is why there can often be outbreaks of adenoviral conjunctivitis.
Signs and symptoms
Only one eye is usually affected at the onset with inflammation spreading to the other in time. Swelling and reddening of the eyelids and conjunctiva, excessive tearing and photophobia are the first manifestations of the disease.
Sometimes the edema is so severe that patients experience difficulties when trying to close their eyes, and the mucous membrane (conjunctiva) is so swollen that it gets trapped between the eyelids (chemosis).
Apart from the clinical signs mentioned above, the complaints include foreign body sensation, gritty eyes, burning and pain, all of which are characteristic of any type of conjunctivitis.
If the infection spreads to the cornea, patients may complain of vision loss, blurry vision, pain and foreign body sensation.
Treatment
Initial signs necessitate immediate medical attention and alcohol avoidance. If you suspect you or your family members have adenoviral conjunctivitis, promptly take the following preventive steps:
- change the affected individual’s towel and pillowcase,
- limit close contact,
- do not use the patient’s personal hygiene products and cosmetics,
- all family members (the patient included) must wash their hands as often as possible.
Non-complicated forms respond well to Poludan in eye drops. If there’s no access to Poludan, it can be substituted with Rheoferon or Pyrogenal — 10 μg).
In 1998, E.A. Kasparova conducted research on over 450 patients and in her dissertation identified three key forms of complicated adenoviral keratoconjunctivitis:
- Severe
- Complicated by toxic and allergic reactions
- Steroid-complicated
All complicated forms are treated with instillations and injections of Poludan. However, LEACKT, antihistamines or antiherpetic agents may be required if clinical presentation warrants it.
Common pitfalls include prescription of high-dose antibacterial, antiherpetic (Zovirax, Acyclovir) agents and steroids (Dexamethasone, Hydrocortisone, Sofradex, Tobradex, etc.).
Corticosteroids offer relatively quick relief, mitigating signs of conjunctivitis and removing redness. However, it is but the calm before the storm, and patients soon pay in full: steroids (be that drops, injections, ointments, etc.) used for viral infections lead to chronicity, promote frequent relapses and ultimately worsen the patient’s condition due to compromised immune response and subsequent activation of the virus. In 25% of cases (E.A. Kasparova, 1998), steroids lead to reactivation of ocular herpes, which makes matters considerably worse.
We developed and patented a treatment modality for severe complicated forms of adenoviral keratoconjunctivitis. It offers good outcomes, preserves vision and speeds up recovery.
Clinical cases
Adenoviral keratoconjunctivitis complicated by toxic and allergic reactions; upon baseline examination the patient had been treated with Bonaphtone and antibiotics for about 1 month.
The same patient, 14 days after treatment.
