Epidemic keratoconjunctivitis

Epidemic keratoconjunctivitis is a hospital infection, more than 70% of patients are infected in medical institutions. The source of infection is a patient with keratoconjunctivitis. Infection spreads by contact, less often - airborne. 

[1], [2], [3], [4], [5], [6]

Factors of transmission of the pathogen are infected hands of medical personnel, eye drops of repeated use, instruments, instruments, eye prostheses, contact lenses. 

[7], [8], [9], [10], [11], [12], [13], [14], [15], [16]

Adenovirus serotypes 8,11, 19, 29 are the main causative agents of epidemic keratoconjunctivitis.

[17], [18], [19], [20], [21], [22]

There are three stages:

• I - acute conjunctival manifestations;
• II - defeat of the cornea;
• III - recovery.

The duration of the incubation period of the disease is 3-14, usually 4-7 days. The onset of the disease is acute, usually both eyes are affected: first one, after 1-5 days - the second. Patients complain of carvings, sensation of a foreign body in the eye, lacrimation. Eyelids are edematous, the conjunctiva of the eyelids is moderately or significantly hyperemic, the lower transitional fold is infiltrated, folded, in most cases reveal small follicles and pinpoint hemorrhages. After 7-8 days, the symptoms of acute conjunctivitis abate, there comes a period of imaginary improvement (2-4 days), followed by a repeated exacerbation of conjunctivitis, accompanied by the appearance of point infiltrates on the cornea. Corneals of both eyes are affected, but on the second diseased eye - in an easier degree. Typical appearance of small, point, subepithelial infiltrates, located under the Bowman membrane, non-coloring fluorescein. The number of them increases within 2-5 days, capturing both the peripheral and the central part of the cornea. In some cases, in addition to the typical subepithelial, superficial fine epithelial infiltrates, colored with fluorescein, are found. In the following weeks infiltrates undergo a slow reverse development. This period is accompanied by an increase in visual acuity, which decreased during the period of profuse corneal eruptions. Sometimes pinpoint corneal opacities regress very slowly, 1-3 years.

Adenoviral conjunctivitis is characterized by high contagiosity. Outbreaks of infection are noted at different times of the year, mainly among adults in organized groups, but more often in eye hospitals or among people who have visited eye care institutions. This is due to the peculiarities of the spread of the disease, mainly transmitted by airborne droplets with adenoviral conjunctivitis and contact - in case of epidemic keratoconjunctivitis.

[23], [24], [25], [26], [27], [28], [29], [30]

Diagnosis of epidemic keratoconjunctivitis

For the diagnosis of adenoviral eye diseases, the immunofluorescence detection of adenoviral antigen in scrapings from the conjunctiva of the eyeball and serological examination of paired sera are of utmost importance, allowing retrospectively to confirm the etiology by increasing the titers of antibodies to the adenoviral antigen.

[31], [32], [33]

Treatment of epidemic keratoconjunctivitis

Treatment is difficult, as there are no medicines for selective effects on adenoviruses. Use preparations of broad antiviral action: interferons (lokferon, ophthalmoferon, etc.) or interferon inducers, conduct installations 6-8 times a day, and in the second week reduce their number to 3-4 times a day. The Vostrom period is additionally instilled with an antiallergic drug allergothal or spersallerg 2-3 times a day and taking antihistamines inside for 5-10 days. In cases of subacute flow, drops of alomide or lecrolin are used 2 times a day. With the films formed and the period of corneal eruptions, corticosteroids (dexapos, maxidex or otan-dexamethasone) are prescribed 2 times a day. With corneal lesions apply typhus, korpozin, vitasik or copegree 2 times a day. In cases of lack of tear fluid for a long period of time, tear-suppressing drugs are used; a natural tear 3-4 times a day, ophthalmic or vidisik-gel 2 times a day.

With recurrent epidemic keratoconjunctivitis, immunocorrective therapy with tactotin (for a course of 6 injections in small doses of 25 μg) or levamisol 75 mg once a week is indicated. For a long time after the epidemic keratoconjunctivitis, tearing was reduced, apparently, due to the defeat of the lacrimal glands. The phenomena of discomfort are removed by the installation of polyglucin or liquidfilm.

Treatment of patients with adenoviral eye diseases should be accompanied by preventive measures such as:

• examination of the eyes of each patient on the day of hospitalization to prevent the introduction of infection in the hospital;
• early detection of cases of development of diseases in the hospital;
• isolation of patients with single cases of disease and quarantine during outbreaks, anti-epidemic measures;
• medical procedures (installation of drops, ointment) should be carried out with an individual sterile pipette and a glass rod; eye drops must be changed daily;
• metal instruments, pipettes, solutions of medicinal substances must be disinfected by boiling for 45 minutes;
• tonometers, instruments and instruments that do not withstand heat treatment, must be decontaminated with a 1% solution of chloramine; after chemical disinfection, it is necessary to rinse these objects with water or rub with a cotton swab moistened with 80% ethyl alcohol to remove disinfectant residues from their surface;
• in order to prevent the transmission of infection by the hands of medical personnel, after each examination or performing medical procedures, wash hands with soap and warm running water, since hand treatment with alcohol is not enough;
• for disinfection of the room, wet cleaning with 1% chloramine solution and ultraviolet irradiation of the air should be carried out;
• In case of an outbreak of the disease, it is necessary to avoid injury to the conjunctiva and the cornea, for which such manipulations as eyelid massage, tonometry, subconjunctival injections, physiotherapy, mucous and eyeball operations are excluded;
• sanitation and educational work.