Adenoviral Conjunctivitis

Adenoviral keratoconjunctivitis presents in two main forms.

• Pharyngoconjunctival fever (serotypes 3, 4, 7): fever, pharyngitis, follicular conjunctivitis, mainly in children, outbreaks in swimming pools and schools.
• Epidemic keratoconjunctivitis (serotypes 8, 19, 37): severe, highly contagious, often spread in clinics; nosocomial outbreaks.
• Spread by respiratory droplets, hand-to-eye contact, contaminated instruments and tonometers; virus survives on surfaces for weeks.
• Incubation 5 to 12 days; infectious for up to 14 days from onset.

• Acute watery discharge, redness, foreign body sensation, eyelid oedema, with unilateral onset and fellow eye involvement 2 to 7 days later (usually milder).
• Follicles, tender preauricular node, chemosis, petechial subconjunctival haemorrhages, pseudomembranes or true membranes (can lead to symblepharon).
• Punctate epithelial keratitis at about 7 days and subepithelial corneal infiltrates (nummular) at 2 weeks, which cause glare, photophobia and reduced vision and can persist for months to years.
• Pharyngoconjunctival fever: fever, sore throat, cervical lymphadenopathy, headache.

• Clinical, usually adequate. Point-of-care immunochromatographic assay (sensitivity about 40 to 90 percent) or PCR for confirmation and outbreak control.
• Slit lamp for follicles, membranes, keratitis and infiltrates; fluorescein staining; visual acuity.
• Differentiate from herpetic eye disease, chlamydia (chronic, follicles, more than 3 weeks) and bacterial conjunctivitis.

• Supportive: cold compresses, preservative free artificial tears hourly to four times daily, topical antihistamine for itch (olopatadine 0.1 percent twice daily).
• Membranes: peel under topical anaesthesia after instilling proparacaine 0.5 percent, then prednisolone acetate 1 percent four times daily.
• Subepithelial infiltrates affecting vision: prednisolone acetate 1 percent four times daily for 1 week, then taper slowly over 4 to 8 weeks (or fluorometholone 0.1 percent), or loteprednol 0.5 percent; alternatively cyclosporine 0.05 to 0.1 percent twice daily as steroid sparing therapy. Infiltrates may recur if steroids are stopped too fast.
• Povidone iodine 5 percent applied to the conjunctiva by a clinician, followed by dexamethasone 0.1 percent four times daily, reduces infectivity and symptoms in some patients.
• Antibiotic prophylaxis is not required, but treat secondary bacterial infection.
• Infection control: contact precautions, exclude from school or work for 14 days or until discharge stops, single use tonometer tips, hand hygiene with soap and alcohol gel (alcohol alone is less effective), disinfect surfaces with sodium hypochlorite.
• Complications: symblepharon, dry eye, persistent infiltrates, corneal scarring. Review in 1 to 2 weeks.