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What Is Epidemic Keratoconjunctivitis?

Epidemic keratoconjunctivitis is a highly contagious viral infection of the conjunctiva and cornea caused by certain adenoviruses. It spreads easily in communities, workplaces, and clinics through contact with tears and contaminated surfaces. Patients present with red, watery, painful eyes and often have a foreign body sensation. After the acute conjunctivitis, subepithelial corneal infiltrates can develop and cause prolonged blur and glare. Outbreaks can last weeks and affect many people.

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What Is Epidemic Keratoconjunctivitis?

Epidemic keratoconjunctivitis is a highly contagious viral infection of the conjunctiva and cornea caused by certain adenoviruses. It spreads easily in communities, workplaces, and clinics through contact with tears and contaminated surfaces. Patients present with red, watery, painful eyes and often have a foreign body sensation. After the acute conjunctivitis, subepithelial corneal infiltrates can develop and cause prolonged blur and glare. Outbreaks can last weeks and affect many people.

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Causes and Transmission of Epidemic Keratoconjunctivitis

Adenovirus serotypes, particularly in groups associated with ocular disease, are responsible for epidemic keratoconjunctivitis. The virus is shed in tears and can survive on instruments, doorknobs, and shared items. Transmission occurs through hand to eye contact, use of contaminated equipment, and sometimes through poorly disinfected tonometers or lenses. Incubation is usually several days. Crowded settings and poor hand hygiene increase spread.

Symptoms and Clinical Features

Symptoms typically start in one eye with redness, tearing, burning, and lid swelling, and then often involve the other eye. Patients may notice photophobia and blurred vision. Systemic symptoms such as malaise or low grade fever can occur. On slit lamp exam, there is follicular conjunctivitis, chemosis, and preauricular lymphadenopathy. Punctate epithelial keratitis develops early, and later, multiple subepithelial infiltrates appear in the central cornea, reducing contrast and causing halos.

How Is Epidemic Keratoconjunctivitis Diagnosed?

Diagnosis is usually clinical, based on the combination of follicular conjunctivitis, preauricular nodes, and a history of exposure or local outbreaks. The eye doctor checks for bilateral involvement, corneal staining, and subepithelial infiltrates. Rapid adenovirus antigen tests on conjunctival swabs are available in some settings and can confirm infection. Other causes of red eye, such as bacterial conjunctivitis, herpes, or allergic disease, are considered and ruled out by history and exam.

How Is Epidemic Keratoconjunctivitis Managed?

There is no specific antiviral therapy for most adenoviral infections, so treatment focuses on comfort and preventing spread. Lubricants, cold compresses, and sometimes topical antihistamine drops help symptoms. In cases with dense subepithelial infiltrates and significant visual disturbance, mild topical steroids are used cautiously to reduce inflammation while monitoring for rebound. Strict hand hygiene, avoidance of shared towels and cosmetics, and disinfection of instruments are important to limit outbreaks.

FAQs About Epidemic Keratoconjunctivitis

How long is epidemic keratoconjunctivitis contagious?

Virus shedding in tears is usually highest in the first one to two weeks, but can sometimes persist longer. Patients are advised to be especially careful with hygiene during this time to protect family, coworkers, and classmates.

Can epidemic keratoconjunctivitis cause permanent vision problems?

Most people recover with good vision, but some are left with persistent subepithelial infiltrates that cause glare and reduced contrast. These changes often fade slowly over months, and topical steroids are sometimes used to speed clearing.

Should I go to work or school if I have epidemic keratoconjunctivitis?

Many clinicians recommend staying home during the most contagious, symptomatic period, especially in roles that involve close contact. If attendance is necessary, scrupulous hand washing and surface cleaning are important.

Can I wear contact lenses during or after epidemic keratoconjunctivitis?

Contact lenses should be stopped during active infection and not resumed until the surface has healed and your doctor approves. Old lenses and cases are usually discarded to reduce the chance of reinfection.