Eyeworld

EW CORNEA 38 January 2017 Types vary Adenoviral conjunctivitis is the most common cause of viral conjuncti- vitis—it causes about 80% of viral conjunctivitis. Three specific types of adenoviral conjunctivitis are usu- ally more aggressive in presentation: epidemic keratoconjunctivitis (EKC), which is usually due to serotypes 8, 19, 37, and 53; acute hemorrhag- ic conjunctivitis (AHC), which is usually due to serotypes 11, 19, and 37; and pharyngoconjunctival fever (PCF), which is due to serotypes 3, 4, 7a, and 11, Dr. de Luise said. However, non-adenoviral con- junctivitis includes herpes simplex virus, which causes about 15% of all cases of viral conjunctivitis. Dr. de Luise said VZV can also be causative, usually as a follicular conjunctivitis. "Most cases of viral conjunc- tivitis cause a follicular reaction," Dr. de Luise said. "However, there are other causes of follicular con- junctivitis that need to be ruled out. Follicular conjunctivitis can be due to a bacterial etiology, and chlamyd- ial conjunctivitis also needs to be considered." Exam keys The adenovirus test has not elimi- nated the need for a full ophthalmic exam in suspected cases of viral conjunctivitis, Dr. Mah said. How- ever, office safeguards are important to prevent the spread of the highly contagious infection. "We do a full ophthalmic exam, but we have them bypass the wait- ing room and go to what we call 'the red eye room,'" Dr. Mah said. Preeya Gupta, MD, assistant professor of ophthalmology, cornea and refractive surgery, Duke Uni- versity Eye Center, Durham, North Carolina, similarly isolates from oth- er patients those who present with signs and history that indicate viral conjunctivitis. The red eye room is regularly cleaned and disinfected. Other measures aimed at limit- ing the spread include Dr. Gupta's use of a Tono-Pen (Reichert Tech- nologies, Depew, New York) with a disposable cover for checking IOP in viral conjunctivitis patients and Dr. Mah's avoidance of commonly used eye drops. Treatment elusive Although there is no Food and Drug Administration (FDA)-approved treatment for viral conjunctivitis, Dr. Mah has offered viral conjunctivitis patients Zirgan (ganciclovir 0.15%, Bausch + Lomb, Bridgewater, New Jersey), as an off-label option, which is approved to treat the herpes virus and has shown efficacy against the adenovirus—including EKC—in some studies. "I tell [suspected viral conjuncti- vitis] patients, 'There is no treatment for adenovirus. We can give you an antibiotic if we are concerned about a bacterial superinfection, however, the viral component will not be affected,'" Dr. Mah said. "If the pa- tient has a particularly inflammatory case of adenoviral conjunctivitis, like EKC, I might talk to them about Zirgan. It may or may not help, and there is currently nothing else that might help that is commercially available." Dr. Gupta recommends patients use aggressive lubrication with pre- servative-free tears, a topical antihis- tamine, and artificial tear ointment to prevent eyelids from sticking or crusting together. Dr. Gupta has added the use of a betadine 5% solution in the office only, which prevents potential toxici- ty from unmonitored home use. Other treatments Other treatment pearls from Dr. Mah include the removal of membranes and pseudomembranes to prevent scarring and permanent ocular surface discomfort from cicatricial changes. Although topical corticosteroids are often prescribed for adenoviral subepithelial infiltrates (SEIs), Dr. de Luise said they remain controversial because they may prolong the pres- ence of SEIs. Topical cyclosporine 0.05% (Restasis, Allergan, Dublin, Ireland) has been used successfully in some cases of adenoviral conjunctivitis, Dr. de Luise said. However, the drug is not FDA labeled for this con- dition. Additionally, Dr. de Luise noted that topical lifitegrast (Xiidra, Shire, Lexington, Massachusetts) has been approved for dry eye disease but has not been evaluated for ade- noviral conjunctivitis. EW Editors' note: Dr. Mah has financial interests with Bausch + Lomb, Shire, and Allergan. Dr. Gupta has financial interests with Shire and Allergan. Dr. de Luise has no financial interests related to his comments. Contact information de Luise: vdeluisemd@gmail.com Mah: Mah.Francis@Scrippshealth.org Gupta: preeya.gupta@duke.edu Viral continued from page 36 Watch for our weekly emails every Saturday, broadcasting recorded live cornea presentations Learn from the experts @http://VideoEd.CorneaSociety.org Copyright ©2017 Cornea Society. All rights reserved. The new Cornea Society VideoEd portal features cornea presentations and expert interviews from educational events throughout the year VideoEd.CorneaSociety.org Watch, Learn & Share! Available on all mobile devices, tablets, and desktops All content is archived for future reference Watch, Learn, and Share! VideoEd

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