EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
118 EW CORNEA March 2013 Making an accurate diagnosis for adenovirus by Francis Mah, M.D. T he signs and symptoms of viral, bacterial, or allergic acute conjunctivitis can be indistinguishable, and we as ophthalmologists think and believe that as reasonable and decent clinicians, we are able to make an accurate diagnosis. However, studies indicate that eyecare professionals make an accurate differential diagnosis for acute conjunctivitis approximately 50% of the time.1-3 To make matters worse, acute conjunctivitis is a highly infectious disease and one associated with significant morbidity. Currently, most practices lack a comprehensive, strategic protocol for Equipment and Services for Cataract | Refractive | Glaucoma Cataract Refractive Mobile Femtosecond Lasers Femtosecond for Cataract Surgery Meet MoFe TM Only Sightpath Medical delivers a mobile solution for laser-assisted cataract surgery, along with everything else you need to make your case day a success. The Sightpath offering is more than simply purchasing or leasing equipment. We provide access to the best technology and an experienced team to support every procedure you perform. VISIT US AT ASCRS IN BOOTH #2238 AT BOOTH Call to learn more about Equipment & Services from Sightpath Medical. Visit SightpathMedical.com/MoFe for more information. managing acute red eye patients. Certainly, ophthalmologists all aspire to make diagnoses with greater accuracy. Having a new diagnostic test, as part of a carefully executed Red Eye Protocol for conjunctivitis, allows me to improve my diagnostic confidence and, subsequently, treatment paradigm. In order to achieve differential diagnosis of acute red eye, I utilize AdenoPlus (Nicox Inc., Dallas), a test designed to confirm or rule out the presence of adenovirus in the red eye. The test boasts an impressive 90% sensitivity and 96% specificity, offering me lab quality diagnostic technology at the point-of-care. Accordingly, the test has become an integral part of the protocol my practice has established. On a weekly basis, I see about 10-25 acute red eye patients. When a patient walks into the office with acute red eye and presents with tearing and discharge, the staff immediately isolates the patient in an examination room instead of having him or her sit in the waiting room. The technician takes the patient's medical history and questions the patient to determine how long he or she has been experiencing symptoms. Knowing that adenovirus is typically more acute as compared to bacterial or allergic conjunctivitis, the length of symptomology can be a useful piece of the puzzle. If the patient's responses are consistent with adenovirus, we administer the AdenoPlus test. If the patient tests positive for adenovirus, I counsel the patient on hygiene to avoid infecting others. In the event that adenovirus looks severe, I may prescribe ganciclovir ophthalmic gel 0.15% (Zirgan, Bausch + Lomb, Rochester, N.Y.). Although it is approved for herpes simplex keratitis and not for adenoviral conjunctivitis, there is evidence that it may have some clinical benefits in certain stereotypes of adenovirus. Furthermore, in a particularly severe infection, any possible ways to decrease the morbidity of the infection may be discussed with the patient. After the patient leaves the room, the technician thoroughly cleans the room with bleach, as transmission with adenovirus is fast and widespread. The infection rate is up to 50% in those who come in close contact with a patient who has adenovirus.4