What is the treatment for keratoconjunctivitis?

Treatment of Keratoconjunctivitis

The treatment of keratoconjunctivitis must be tailored to the specific type, with discontinuation of contact lens wear being essential for contact lens-related cases, topical corticosteroids for inflammatory variants, and appropriate antibiotics for infectious forms. 1

Types of Keratoconjunctivitis and Their Treatments

Superior Limbic Keratoconjunctivitis (SLK)

• Mild cases respond to treatment of concomitant dry eye syndrome with lubricants, mast-cell stabilizers, cyclosporine, soft contact lenses, and/or punctal occlusion 1
• Associated filamentary keratitis may respond to topical 10% acetylcysteine or hypertonic (5%) saline 1
• Persistent symptoms may require surgical intervention such as cautery (chemical or thermal) to tighten redundant conjunctiva or conjunctival resection 1
• Investigate underlying thyroid dysfunction (present in up to 65% of SLK patients) with thyroid antibody tests 1
• Inform patients that SLK is a chronic, recurrent condition that rarely decreases vision 1

Contact Lens-Related Keratoconjunctivitis

• Immediately discontinue contact lens wear until the cornea returns to normal 1, 2
• For mild to moderate cases, prescribe a brief (1-2 weeks) course of topical corticosteroids 1, 2
• Consider longer-term use of topical cyclosporine 0.05% 1, 2
• At follow-up, review contact lens fit, type, and care regimen; consider non-preserved lens care systems, daily disposable lenses, high DK/T ratio material, and reduced wearing time 1, 2
• Consider alternatives to contact lenses (eyeglasses or refractive surgery) once resolved 1, 2
• Rule out Acanthamoeba keratitis if moderate or severe pain is present 1, 2

Giant Papillary Conjunctivitis (GPC)

• Treatment involves modifying the causative entity (contact lenses, sutures, ocular prostheses) 1
• For contact lens-related GPC: replace lenses more frequently, decrease wearing time, use preservative-free care systems, administer mast-cell stabilizing agents, refit lenses, switch to daily disposables, or change lens polymer 1
• Treat associated abnormalities such as aqueous tear deficiency and meibomian gland dysfunction 1
• Consider discontinuation of contact lens use with topical anti-inflammatory agents 1

Allergic and Vernal Keratoconjunctivitis

• For seasonal or perennial conjunctivitis: combination of decongestants and antihistamines as first-line palliative treatment 3
• Use mast cell stabilizers for prophylaxis 3, 4
• For vernal and atopic keratoconjunctivitis: courses of topical corticosteroids to prevent flares 3, 4
• Mast cell stabilizers (particularly lodoxamide) for prophylactic therapy 3
• Calcineurin inhibitors may be beneficial for atopic keratoconjunctivitis 4, 5
• Control vernal and atopic keratoconjunctivitis prior to any corneal cross-linking to decrease risk of sterile keratitis 1

Medication-induced/Preservative-Induced Keratoconjunctivitis

• Discontinue the responsible agent, which usually results in resolution over weeks to months 1
• For severe inflammation, prescribe a brief course of topical corticosteroids, preferably with preservative-free formulations 1
• Use nonpreserved artificial tears or low-dose topical corticosteroids 1
• Monitor for subepithelial fibrosis 1

Rosacea Conjunctivitis

• Treatment includes eyelid hygiene, warm compresses, systemic tetracyclines, topical corticosteroids and cyclosporine, topical metronidazole creams/ointment, mechanical thermal pulsations, and intense pulse light therapy 1

Special Considerations

Viral Conjunctivitis (Adenoviral)

• Treatment is mostly supportive as most cases are self-limited 6, 7
• Educate patients about proper hygiene to prevent transmission 1, 7
• Counsel infected individuals to wash hands frequently, use separate towels and pillows, and avoid close contact with others during the contagious period (10-14 days from onset) 1, 7

Bacterial Conjunctivitis

• Most uncomplicated cases resolve in 1-2 weeks 6
• Topical antibiotics decrease duration and allow earlier return to school or work 6
• For conjunctivitis secondary to sexually transmitted diseases (chlamydia, gonorrhea), systemic treatment is required in addition to topical antibiotics 6
• Gonococcal conjunctivitis requires immediate systemic therapy as it is vision-threatening 1, 6

Monitoring and Follow-up

• Frequency of follow-up visits depends on severity of disease presentation, etiology, and treatment 1
• Follow-up should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
• If corticosteroids are prescribed, perform baseline and periodic measurement of intraocular pressure and pupillary dilation to evaluate for glaucoma and cataract 1

Important Pitfalls to Avoid

• Avoid indiscriminate use of topical antibiotics or corticosteroids 1
• Be vigilant for chronic/recalcitrant conjunctivitis, which may indicate underlying malignancy, inflammatory condition, or chronic infection 1
• Do not resume contact lens wear too early before complete resolution 2
• Remember that viral conjunctivitis will not respond to antibacterial agents 1, 7
• Consider that keratoconjunctivitis may be associated with systemic diseases requiring further investigation 1