Eyeworld

EW CORNEA 36 January 2017 by Rich Daly EyeWorld Contributing Writer Although widely effective treatments for various types of viral conjunctivitis remain uncertain, a diagnostic test has proven reliable in the clinical setting A n in-office test for the most common type of viral conjunctivitis has become a reliable staple for cornea specialists faced with suspected cases. AdenoPlus (Rapid Pathogen Screening, Sarasota, Florida), which is a colorimetric test similar to a pregnancy test, takes about 10 min- utes to indicate whether a patient has the DNA of the adenovirus on the surface of his or her eye. The introduction of the test challenged the traditional use of clinical exam and history in suspected cases of viral conjunctivitis. Although those earlier diagnostic approaches can be effective, research co-authored by Francis Mah, MD, director, cornea and external disease, and co-direc- tor, refractive surgery, Scripps Clinic Medical Group, La Jolla, California, found even academic cornea special- ists correctly diagnose only about half of such cases when using just an exam and history. "AdenoPlus is helpful in the positive but also helpful in the negative because that means you are looking at something else, wheth- er it is bacteria, dry eyes, allergies, etc.," Dr. Mah said about the test, which has 90% sensitivity and 96% specificity. If the test is positive, isolation and quarantine from school or work for at least 7 days is recommended, said Vincent de Luise, MD, assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, Connecticut. "If the test is negative, the etiology is likely not adenoviral in origin; then the clinician needs to pursue a diagnostic workup for other etiologies, such as herpes simplex, varicella zoster virus (VZV), or other causes," Dr. de Luise said. Viral conjunctivitis test may help practices D uring fall and winter in our emergen- cy clinics, it seems like an epidemic of adenoviral conjunctivitis cases appear. Often we can spot the patients from across the room with severe bilateral red eyes and tearing, and they have an upper respiratory tract infection with preauricular lymphadenopathy. However, sometimes patient symp- toms may not be so obvious, especially if the conjunctivitis is mild, it is early on in the disease process, patient symptoms are monocular only, or the presentation is atypical. Two ophthalmology colleagues of mine reported that this past winter at their respective hospitals, they each had a pa- tient misdiagnosed as orbital cellulitis and admitted for intravenous antibiotics, when in fact the patients had severe adenoviral conjunctivitis. An in-office test, AdenoPlus, is avail- able as an aid for immediate diagnosis. A swab for PCR (polymerase chain reaction) testing can also be done, but results can be delayed. Some clinicians proceed with a full comprehensive assessment at the patient's first visit while acutely infectious, and others may elect to discharge the patient with the presumed diagnosis and supportive care to have the patient return 2 weeks later when no longer contagious. Other than supportive care, there may be a role for topical antivirals and betadine solution. Francis Mah, MD, Preeya Gupta, MD, and Vincent de Luise, MD, discuss pearls for the diagnosis and management of adenoviral conjunctivitis in this month's "Cornea editor's corner of the world." Clara Chan, MD, FRCSC, FACS, Cornea editor Cornea editor's corner of the world Membranous conjunctivitis Post-viral, subepithelial infiltrates Follicular conjunctivitis Source: Francis Mah, MD continued on page 38

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