<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Abstract

Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, antiinflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.

SARS-CoV-2 RNA detection in tears and conjunctival secretions of COVID-19 patients with conjunctivitis

“…Transmission may occur through accidental inoculation of viral particles from the patient's hands or by direct eye contact with infected upper respiratory droplets or contaminated fomites, as it happens in other types of viral conjunctivitis such as adenoviral conjunctivitis. 8 …”

COVID-19 Disease and Ophthalmology: An Update

“…Some treatment modalities have been investigated, such as systemic and topical antivirals, in-office povidone-iodine irrigation, immunoglobulin-based therapy, anti-inflammatory therapy and immunotherapy. Other posible therapeutic options are sialic acid analogs, cold atmospheric plasma, Nchlorotaurine and benzalkonium chloride [68].…”

Virucidal benefits of povidone-iodine use on the ocular surface: a review

“…Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases. 17 Patients can develop a keratoconjunctivitis, with subepithelial corneal infiltrates that can cause long-term visual impairment. 17 At least 19 different serotypes of HAdV have been associated with epidemic keratoconjunctivitis, with serotypes 8, 19 and 37 being the most common.…”

“… 17 Patients can develop a keratoconjunctivitis, with subepithelial corneal infiltrates that can cause long-term visual impairment. 17 At least 19 different serotypes of HAdV have been associated with epidemic keratoconjunctivitis, with serotypes 8, 19 and 37 being the most common. 18 Persistent HAdV secretions in the tears may occur years following the resolution of acute ocular infection.…”

“… 18 Persistent HAdV secretions in the tears may occur years following the resolution of acute ocular infection. 17 There are currently no licensed treatments for adenoviral keratoconjunctivitis, with conservative management options such as cold compresses and artificial tears alleviating symptoms, rather than reducing viral shedding, which would limit severity and duration of infection.…”