Table of ContentsView AllTable of ContentsSymptomsComplicationsCausesSDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
Complications
CausesS
Diagnosis
Treatment
Prevention
Epidemic keratoconjunctivitis (EKC), also known asadenoviral keratoconjunctivitisorkeratoconjunctivitis epidemica, is a highly contagious eye infection that affects both the cornea (the clear front surface of the eye) and theconjunctiva(the white of the eye). As the name suggests, the disease occurs in clusters in places like schools, camps, and nursing homes.
This article describes the causes and symptoms of epidemic keratoconjunctivitis, including how the infection is diagnosed and treated. It also explains how the virus is contagious, how it is spread, and what steps are taken to prevent infection.
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DefinitionsInflammation of the cornea is calledkeratitis, while inflammation of the conjunctiva is calledconjunctivitis(or “pink eye”).
Definitions
Inflammation of the cornea is calledkeratitis, while inflammation of the conjunctiva is calledconjunctivitis(or “pink eye”).
What Are Symptoms of Epidemic Keratoconjunctivis?
Epidemic keratoconjunctivitis follows a specific pattern with symptoms occurring in stages known as the prodromal, acute, and chronic phases.
Prodromal Phase
Prodromerefers to the non-specific, generalized early symptoms that precede the onset of a disease. During this time, a person with EKC may not realize they are infected but can still pass the virus to others.
The prodromal phase for EKC can last anywhere from two days to a week and manifest with flu-like symptoms such as:
Acute Phase
The acute phase lasts seven to 10 days, causing overt symptoms easily recognized as an eye infection.
The infection will initially be unilateral (affecting one eye) before becoming bilateral (affecting two eyes) in 70% of cases. This almost invariably happens when a person touches their infected eye and then their uninfected eye with the same hand (referred to asself-inoculation).
How Long Does Epidemic Keratoconjunctivitis Last?Acute symptoms of epidemic keratoconjunctivitis usually resolve in two weeks, although some cases have been known to persist for as long as six weeks. Until symptoms fully resolve, the virus is still considered contagious.
How Long Does Epidemic Keratoconjunctivitis Last?
Acute symptoms of epidemic keratoconjunctivitis usually resolve in two weeks, although some cases have been known to persist for as long as six weeks. Until symptoms fully resolve, the virus is still considered contagious.
Chronic Phase
The chronic phase affects 50% of people with EKC. It is the period during which the immune system is actively reining and eventually resolves the infection.
Even after the infection is fully cleared, these symptoms can persist for months and sometimes years. While the damage is rarely permanent, the symptoms can be aggravating.
Possible Complications
Though epidemic keratoconjunctivitis usually only causes temporary corneal opacity, severe infections can cause scarring of thesymblepharon formation(where the eyeball meets the eyelid). Damage to this structure can cause discomfort when blinking and reduced teardrop production, leading tokeratoconjunctivitis sicca(dry eye syndrome).
Other rare but possible complications includeastigmatismin which vision is blurred due to changes in the shape of the cornea.
Severe EKC coupled with aggressive eye rubbing can also cause corneal perforation which, in turn, can lead to asecondary bacterial infection, eye damage, and permanent vision loss.
When to See a Healthcare Provider About Eye Pain
What Is the Most Common Cause of Epidemic Keratoconjunctivitis?
Adenoviruses thrive in the eyes, nasal passages, saliva, and respiratory tract. Their thick protein shells (called capsids) are resistant to environmental conditions, allowing them to be spread from person to person or aerosolized and spread whenever a person sneezes.
Possible modes of transmission include:
EKC infections tend to occur in clusters, particularly in closed institutions such as schools, daycare centers, hospitals, nursing homes, and workplaces.
Adenovirus particles can remain on surfaces for more than one month and cause reinfection until the surfaces are properly sanitized.
How Epidemic Keratoconjunctivitis Is Diagnosed
EKC can usually be diagnosed with a simpleeye exam. A lighted magnifying glass, called a slip lamp, can check for characteristic signs of EKC, such as corneal opacity and subepithelial infiltrates. The practitioner may also check for swollen lymph nodes in the neck.
A slit lamp in conjunction with magnifying lenses or an ophthalmoscope may be used to check the back of the eye if the symptoms are severe or persistent.
In most cases, treatment would begin if the symptoms are uncomplicated. If the diagnosis is uncertain or the presentation of symptoms is unusual, the healthcare provider can use a simple, in-office test to detect the presence of adenovirus in the eye.
Adenovirus Swab Test
Adenovirus swab tests are highly sensitive rapid tests that can confirm an adenovirus infection within around 10 minutes. Available under such brand names as RP Adeno Detector and AdenoPlus, the test involves running a soft swab between the lower eyelid and conjunctiva to obtain a sample of fluid.
Newer-generation swab tests have a sensitivity of between 95.5% to 98% and a specificity of between 39.5% and 85%. Because of the low specificity, there is a risk of a false-positive result.
The swab test is non-invasive but may cause discomfort. An anesthetic eyedrop may be used for people who dislike having their eyeballs touched.
Adenovirus swab tests should ideally be done within the first seven days of the appearance of symptoms to ensure the most accurate results.
How Epidemic Keratoconjunctivitis Is Treated
EKC infections usually resolve on their own without treatment. At present, there are no oral or topical antiviral drugs able to clear the infection. Treatment is primarily focused on the relief of symptoms and the prevention of complications.
Among some of the more common treatment options:
How to Treat and Get Rid of Red Eyes
How to Prevent Epidemic Keratoconjunctivitis
EKC is a highly contagious disease and one that requires vigilance to prevent further spread of the infection. Children with EKC should stay home from school until symptoms have resolved. Adults can continue to go to work as long as they continue to adhere to infection control measures.
To avoid getting or spreading EKC during an outbreak:
How to Wash Your Hands the Right Way
Summary
From start to finish, EKC infections usually last two weeks. The treatment of EKC is focused on easing symptoms with eye drops and cold compresses. Handwashing and isolation are two key ways to prevent passing the virus to others.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Epidemic keratoconjunctivitis: prevention strategies in the clinic.Chigbu DI, Labib BA.Pathogenesis and management of adenoviral keratoconjunctivitis.Infect Drug Resist. 2018;11:981-93. doi:10.2147/IDR.S162669Dela Cruz CS, Pasnick S, Gross JE, et al.Adenovirus infection and outbreaks: What you need to know.Am J Respir Crit Care Med.2019;199:13-4. doi:10.1164/rccm.1997P13Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers PM, Gesser C.Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment.Dtsch Arztebl Int. 2011;108(27):475-80. doi:10.3238/arztebl.2011.0475Kuo IC.Adenoviral keratoconjunctivitis: Diagnosis, management, and prevention.Curr Ophthalmol Rep.2019;7:118. doi:10.1007/s40135-019-00207-yHoltz KK, Townsend KR, Furst JW, et al.An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.Mayo Clin Proc Innov Qual Outcomes.2017;1(2):170-5. doi:10.1016/j.mayocpiqo.2017.06.001Holland E, Fingeret M, Mah F.Use of topical steroids in conjunctivitis.Cornea. 2019;38(8):1062-7. doi:10.1097/ico.0000000000001982
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Epidemic keratoconjunctivitis: prevention strategies in the clinic.Chigbu DI, Labib BA.Pathogenesis and management of adenoviral keratoconjunctivitis.Infect Drug Resist. 2018;11:981-93. doi:10.2147/IDR.S162669Dela Cruz CS, Pasnick S, Gross JE, et al.Adenovirus infection and outbreaks: What you need to know.Am J Respir Crit Care Med.2019;199:13-4. doi:10.1164/rccm.1997P13Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers PM, Gesser C.Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment.Dtsch Arztebl Int. 2011;108(27):475-80. doi:10.3238/arztebl.2011.0475Kuo IC.Adenoviral keratoconjunctivitis: Diagnosis, management, and prevention.Curr Ophthalmol Rep.2019;7:118. doi:10.1007/s40135-019-00207-yHoltz KK, Townsend KR, Furst JW, et al.An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.Mayo Clin Proc Innov Qual Outcomes.2017;1(2):170-5. doi:10.1016/j.mayocpiqo.2017.06.001Holland E, Fingeret M, Mah F.Use of topical steroids in conjunctivitis.Cornea. 2019;38(8):1062-7. doi:10.1097/ico.0000000000001982
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Ophthalmology.Epidemic keratoconjunctivitis: prevention strategies in the clinic.Chigbu DI, Labib BA.Pathogenesis and management of adenoviral keratoconjunctivitis.Infect Drug Resist. 2018;11:981-93. doi:10.2147/IDR.S162669Dela Cruz CS, Pasnick S, Gross JE, et al.Adenovirus infection and outbreaks: What you need to know.Am J Respir Crit Care Med.2019;199:13-4. doi:10.1164/rccm.1997P13Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers PM, Gesser C.Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment.Dtsch Arztebl Int. 2011;108(27):475-80. doi:10.3238/arztebl.2011.0475Kuo IC.Adenoviral keratoconjunctivitis: Diagnosis, management, and prevention.Curr Ophthalmol Rep.2019;7:118. doi:10.1007/s40135-019-00207-yHoltz KK, Townsend KR, Furst JW, et al.An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.Mayo Clin Proc Innov Qual Outcomes.2017;1(2):170-5. doi:10.1016/j.mayocpiqo.2017.06.001Holland E, Fingeret M, Mah F.Use of topical steroids in conjunctivitis.Cornea. 2019;38(8):1062-7. doi:10.1097/ico.0000000000001982
American Academy of Ophthalmology.Epidemic keratoconjunctivitis: prevention strategies in the clinic.
Chigbu DI, Labib BA.Pathogenesis and management of adenoviral keratoconjunctivitis.Infect Drug Resist. 2018;11:981-93. doi:10.2147/IDR.S162669
Dela Cruz CS, Pasnick S, Gross JE, et al.Adenovirus infection and outbreaks: What you need to know.Am J Respir Crit Care Med.2019;199:13-4. doi:10.1164/rccm.1997P13
Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers PM, Gesser C.Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment.Dtsch Arztebl Int. 2011;108(27):475-80. doi:10.3238/arztebl.2011.0475
Kuo IC.Adenoviral keratoconjunctivitis: Diagnosis, management, and prevention.Curr Ophthalmol Rep.2019;7:118. doi:10.1007/s40135-019-00207-y
Holtz KK, Townsend KR, Furst JW, et al.An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.Mayo Clin Proc Innov Qual Outcomes.2017;1(2):170-5. doi:10.1016/j.mayocpiqo.2017.06.001
Holland E, Fingeret M, Mah F.Use of topical steroids in conjunctivitis.Cornea. 2019;38(8):1062-7. doi:10.1097/ico.0000000000001982
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