Which clinical history findings are characteristic of adenovirus-related epidemic keratoconjunctivitis?

Updated: Apr 15, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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This is highly contagious, with approximately 10% transmission in household contacts via hands and fomites. Transmission has also been associated with instrumentation, industrial trauma (shipyard workers [ie, shipyard eye], welders, airborne particles), contaminated ophthalmic solutions, and the hands of health care workers. [19]  Corneal trauma facilitates infection.

After an 8-day incubation period, an insidious onset of unilateral red eye occurs (conjunctival inflammation), with excessive tearing, spreading to involve both eyes within 5 days. Eyelid swelling, foreign-body sensation and irritation or itching may occur. Onset of photophobia, tearing, and pain after approximately 4 days heralds the characteristic corneal involvement with superficial punctate epithelial conjunctivitis. Parinaud's syndrome (pre-auricular lymphadenopathy) is a feature in over 50% of cases. This finding, along with conjunctivitis, strongly suggests adenoviral ocular infection. Fever, malaise and headache are reported. Pseudomembranes may occur as well and may lead to tarsal scarring if not removed. 

Although the disease is self-limited and rarely results in permanent corneal damage, keratitis findings may run a protracted course lasting up to four weeks. Mild visual impairment may occur. In some patients, subepithelial infiltrates develop as conjunctivitis begins to wane, and may reflect a delayed hypersensitivity reaction. These infiltrates may persist for weeks to months. 

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