What is the treatment for adenoviral keratoconjunctivitis?

Treatment of Adenoviral Keratoconjunctivitis

Adenoviral keratoconjunctivitis is primarily a self-limited condition that requires supportive care rather than antimicrobial treatment. 1 The management focuses on symptom relief and preventing transmission while the infection runs its course.

Supportive Treatment Approach

First-line Management

• Cold compresses: Apply to reduce inflammation and provide symptomatic relief
• Artificial tears: Use preservative-free formulations for lubrication and comfort
• Topical antihistamines: May help reduce itching and discomfort
• Oral analgesics: For pain management if needed

Important Considerations

• Avoid antibiotics: Antibiotics should be avoided as they have no effect on viral infections and may cause toxicity 1
• Corticosteroid use: Only consider in severe cases with marked chemosis, eyelid swelling, epithelial sloughing, or membranous conjunctivitis 1
  • Requires close follow-up as steroids may potentially prolong viral shedding
  • Not indicated for routine cases

Specific Management for Severe Cases

Membrane Management

• If membranes or pseudomembranes are present, consider gentle debridement to prevent corneal epithelial abrasions or permanent cicatricial changes 2

Corticosteroid Considerations

• Only use topical corticosteroids for severe inflammation with close monitoring
• Caution: Corticosteroids can potentially prolong adenoviral infections and worsen HSV infections 1
• If corticosteroids are used, taper appropriately and monitor for complications

Infection Control Measures

Patient Education

1. Contagious period: Patients should be considered contagious for 10-14 days from symptom onset 1
2. Hand hygiene: Frequent handwashing with soap and water (not just sanitizer) 1
3. Personal items: Use separate towels and pillows 1
4. Social distancing: Avoid close contact with others, especially for healthcare workers and childcare providers 1

Clinical Setting Precautions

• Equipment disinfection: Use dilute bleach soaks (1:10 sodium hypochlorite) for tonometer tips 1
  • Immerse for 5-10 minutes followed by thorough rinsing and air drying
  • Important: 70% isopropyl alcohol wipes are NOT adequate for disinfection 1
• Surface decontamination: Clean exposed surfaces with 1:10 dilution of household bleach 1
• Defer non-essential procedures: Consider postponing IOP measurement unless absolutely necessary 1
• Triage protocol: Consider a dedicated "red-eye room" during outbreaks 1

Follow-up Recommendations

• Routine follow-up in 1-2 weeks for uncomplicated cases
• More frequent monitoring (every few days) for patients with:
  • Severe inflammation
  • Corneal involvement
  • Those using topical corticosteroids

Common Pitfalls to Avoid

1. Inappropriate antibiotic use: Antibiotics have no effect on viral infections and may cause toxicity
2. Inadequate disinfection: Using alcohol wipes instead of dilute bleach for tonometer disinfection
3. Insufficient patient education: Not emphasizing the highly contagious nature of the infection
4. Premature return to work: Allowing patients to return to high-risk occupations (healthcare, food service) before the contagious period ends
5. Unmonitored corticosteroid use: Using steroids without close follow-up can prolong viral shedding

Remember that adenoviral keratoconjunctivitis is extremely contagious and can survive on surfaces for up to 28 days 1. Proper infection control measures are essential to prevent outbreaks, especially in healthcare settings.