Eyeworld

EW FEATURE 42 Navigating the red eye • May 2018 AT A GLANCE • Pink eye might be one of the most commonly seen ocular infections by eye care professionals, but differ- entiating among bacterial, viral, and other conjunctivitis makes all the difference in determining an appro- priate treatment course. • Bacterial conjunctivitis is more likely to be monocular, presents with a thicker, mucus-like discharge, and can be treated with antibiotics, though it's self-limiting without them. • Viral conjunctivitis, given its more infectious nature, is more likely to be binocular, presenting with a watery discharge and more inflammation. • Epidemic keratoconjunctivitis is a type of viral conjunctivitis caused by adenoviruses. It is extremely contagious, and patients with these infections can develop membranes and corneal subepithelial infiltrates. by Liz Hillman EyeWorld Senior Staff Writer factors that differentiates EKC from others, besides the severe nature of inflammation, is people can de- velop membranes. Membranes are this tenacious exudate that's on the conjunctival surface, usually the palpebral conjunctival surface, or the under surface of the eyelids," Dr. Mah said. EKC can also cause corneal sub- epithelial infiltrates (SEIs). Dr. Mah said SEIs usually appear after the infectious period while membranes appear earlier in the disease process. Christopher Starr, MD, director of refractive surgery and director of the cornea, cataract, and refrac- tive surgery fellowship program, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, said he uses AdenoPlus (Quidel, San Diego), a testing kit that can confirm adenoviral con- junctivitis, on all patients suspected of having acute viral or bacterial conjunctivitis. "When positive, it confirms the diagnosis and allows me to be confident that not prescribing an antibiotic is appropriate," Dr. Starr said. Treatment plans Treatment of pink eye depends on its etiology, Dr. Verdier said, noting that one should be sure to not over- look possibilities of dry eye, bleph- aritis, acne rosacea, lagophthalmos or lid anomalies, or neurotropic conditions, which should be treated years or older] are associated more with viral conjunctivitis," Dr. Mah said, explaining that he thinks this is likely due to a more developed immune response. Viral conjunctivitis is also generally more contagious and thus more likely to spread to the other eye. "Normally what happens with viral is one eye starts it off and be- cause it's so contagious, a day or two later, it goes to the second eye, and generally the second eye's reaction is not as severe," Dr. Mah said. If the patient experiences chronic or recurrent conjunctivitis, David Verdier, MD, Verdier Eye Center, Grand Rapids, Michigan, recommended consideration of herpes simplex virus (HSV), non- infectious dry eye, acne rosacea, or exposure and/or neurotrophic involvement as the possible cause. Knowing when it's EKC Epidemic keratoconjunctivitis (EKC) is an extremely contagious and more severe form of viral conjunc- tivitis, which presents with even more severe inflammation and other hallmark features. While Dr. Mah said any virus that can cause an infection in hu- mans could cause a case of con- junctivitis, there are specific types of adenoviruses that are associated with EKC. "With EKC, you have a lot more inflammation around the eyes, a lot more symptoms, but one of the key seems like the patient has pink eye, but what kind? At least among the general public, the term "pink eye" has be- come synonymous with infectious conjunctivitis, either viral or bacteri- al, said Francis Mah, MD, director of corneal and external disease and co-director of refractive surgery, Scripps Clinic, La Jolla, California. He acknowledged, however, that there are a lot of different condi- tions that could cause redness or inflammation of the eye beyond a bacterial or viral infection. For the purposes of this article, experts focused on the diagnosis and treatment of the more com- mon bacterial and viral infectious conjunctivitis. Differentiating between the two A big symptom that differentiates bacterial from viral conjunctivitis is the discharge. Dr. Mah said bacterial conjunctivitis is associated with a thicker, goopy discharge that can cause the eyelids, in some cases, to stick together, while viral conjunc- tivitis causes a more watery, teary discharge. In addition, he said that in- flammation is more prevalent and pronounced with viral infections. Other factors to consider, according to Dr. Mah, are the patient's age and whether the infection is binocular or monocular. "In general, children are asso- ciated more with bacterial conjunc- tivitis, whereas older patients [10 Diagnosing, treating, and preventing spread of viral and bacterial conjunctivitis A patient comes into the clinic with red, irritated eyes. Perhaps there is a goopy or watery discharge and some swelling. It Perspectives on pink eye Bacterial conjunctivitis (left) presents with a more oozy discharge that can crust over, while viral conjunctivitis (right) is characterized by a more watery discharge and severe inflammation. Source: Francis Mah, MD

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