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Background: Corneal subepithelial infiltrates (SEIs) are characteristic clinical findings of adenoviral keratoconjunctivitis (AKC). In eyes with SEIs, both corneal opacity and irregular astigmatism may interfere with vision. However, irregular astigmatism is often overlooked in patients with AKC. Here, we report a case of decreased vision due to irregular corneal surfaces detected by Placido ring mires in eyes with corneal SEIs after AKC., Case Presentation: An 8-year-old girl with decreased vision was referred to our clinic. She had been diagnosed with AKC two years prior by a different physician. Thereafter, she experienced recurring episodes of decreased vision, epiphora, and photophobia in both eyes. The symptoms persisted despite resolution of the corneal opacity with steroid eye drops. Despite mild corneal opacity, both eyes exhibited distorted Placido ring patterns on corneal topography. The decreased vision in both eyes was due to the irregular corneal surface caused by SEIs, rather than corneal opacity. Topical 0.1% tacrolimus eye drops were effective in treating corneal opacity and irregular corneal surfaces., Conclusions: Our findings highlight that vision loss due to SEIs after AKC may stem from an irregular corneal surface regardless of corneal opacity severity, and the usefulness of a conventional and simple topography using Placido rings during treatment with 0.1% tacrolimus eye drops for SEIs in AKC., Competing Interests: Declarations. Ethics approval and consent to participate: This case report and the use of tacrolimus eye drops to treat SEIs after AKC were approved by the Institutional Review Board of Nagata Eye Clinic (#2018-004). Consent for publication: Written informed consent was obtained from the patient’s parents for the publication of this case. The patient’s anonymity was ensured. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose : To examine the effects of treatments performed on children with adenoviral conjunctivitis. Methods : 50 children with Adenoviral keratoconjunctivitis (AK) were evaluated. Patients were divided into four groups according to the medical treatment agents that were used previously. AK symptoms were clinically scored and analyzed. The diagnosis of all children was confirmed by an in-office lateral flow immunoassay. Results : Fifty patients with AK were included in the study. 24 (48%) were female and 26 (52%) were male. The mean age was 12.88 ± 2.66 (8-17). In PVP-I groups clinical findings shows faster improvement than other groups ( p < .05). Conclusions : Conjunctival irrigation with 2.5% PVP-I is very effective for the treatment of adenoviral conjunctivitis in childhood. Ganciclovir ophthalmic gel 0.15% increases the effect of 2.5% PVP-I on AK, but this was not statistically significant.

Abstract: The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate the correlation between corneal involvement and anterior chamber flare using a laser flare meter in eyes with epidemic keratoconjunctivitis., Methods: A total of 82 eyes of 50 (32 female and 18 male) consecutive patients with epidemic keratoconjuctivitis were evaluated. Besides complete opthalmic examination, anterior chamber flare measurements with laser flare meter (FM 600, Kowa, Kowa Company Ltd., Nagoya, Japan) were performed. The relationship between corneal involvement, subepithelial deposits, and anterior chamber flare was assessed., Results: The mean age of the patients was 36.32 ± 18.77 (range 4-75) years and the mean duration of complaints was 5.28 ± 2.65 (range 1-12) days. The biomicroscopic findings were conjunctival hyperemia in 82 (100%), follicular reaction in 66 (80.5%), eyelid edema in 56 (68.3%), punctate epitheliopathy in 38 (46.3%), and subepithelial deposits in 36 (43.9%) eyes. The mean flare value was 17.35 ± 12.62 (range 2.0-45.0) photons/ms. Flare measurements were significantly higher in eyes with subepithelial deposits (p < 0.001)., Conclusions: Subepithelial deposits seem to occur in eyes with higher anterior chamber inflammation in epidemic keratoconjunctivitis. The laser flare meter might be a useful tool to predict subepithelial deposit development in these patients.

Purpose: To determine the efficacy of combination povidone-iodine (PVP-I) 1.0% eyedrops and dexamethasone 0.1% eyedrops in the treatment of adenoviral keratoconjunctivitis., Materials and Methods: In a prospective, randomized, controlled, double-blinded clinical trial patients with recent adenoviral keratoconjunctivitis (diagnosed clinically and confirmed by PCR), we randomly divided into three treatment groups: study group - received PVP-I 1.0% and dexamethasone 0.1%, control 1 group - received dexamethasone 0.1% and control 2 group - received lubricating eyedrops (hypromellose 0.3%). The treatment was administered four times a day in each group. All patients were examined and filled a questionnaire before treatment and on the 3rd, 5th and 7th days of treatment., Results: We included in the study 78 eyes (26 in each group). Adenovirus type 8 was the most common pathogen (83% of cases). The fastest improvement in patients red eyes, discharge, superficial punctate keratitis and pseudomembranes was observed in the study group (p < 0.001). Those patients reached a near complete recovery in 5-7 days, which was also confirmed by reduction in Adenovirus titres by PCR. The slowest improvement was in the control 2 group. Subepithelial infiltrates (SEI) were observed in 44% of the control 1 group, 20% of the control 2 group and in 0% of the study group. The rate of reduction in Adenovirus titres was the slowest in the control 1 group., Conclusion: The combination of PVP-I 1.0% and dexamethasone 0.1% four times a day can reduce symptoms and expedite recovery in epidemic keratoconjunctivitis patients., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: The objective of this study was to determine the efficacy and safety of topical tacrolimus compounded in the Pharmacy Service for the treatment of subepithelial corneal infiltrates (SEIs) secondary to adenoviral keratoconjunctivitis., Methods: This retrospective study included patients who had been dispensed topical tacrolimus for the treatment of SEIs during the previous year. Patients were treated with tacrolimus 0.03% eye drops twice daily or tacrolimus 0.02% ointment once daily. The following data were recorded: length of treatment, visual acuity before and after treatment, intraocular pressure before, during, and at the end of treatment, previous treatments, and the presence of SEIs after treatment. The subjective symptoms of the patients were also assessed., Results: Fifty-five patients (85 eyes) were included, 54.5% with bilateral involvement. A total of 31 (36.5%) eyes were treated with tacrolimus ointment and 54 eyes (63.5%) with tacrolimus eye drops. The median length of treatment was 185 days (p25-75: 93.5-426), and the mean follow-up duration was 363 days (p25-75: 148-540). In 62.35% of the eyes, the SEIs were reduced in number and size, and in 31.76%, they were eliminated. The patients had better visual acuity after treatment with highly statistically significant differences. Tolerance was good overall, being better in the eye drops group., Conclusions: Topical tacrolimus, compounded in the pharmacy, seems to be an effective and safe alternative for the treatment of SEIs secondary to adenovirus keratoconjunctivitis.

PurposeTo compare the clinical outcome with different treatment regimens in Acute Adenoviral Keratoconjunctivitis (AAK).MethodsThe records of 110 patients diagnosed as AAK in two tertiary eye care centers were evaluated retrospectively. The treatment regimen, follow-up duration, time until improvement of the symptoms, visual acuity, clinical findings, Schirmer's test and the Ocular Surface Disease Index (OSDI) score at the first day, first week and third week were recorded. The Kruskal-Wallis Test and Chi-square test were used for comparison of quantitative and categorical variables, respectively.ResultsForty six patients were receiving topical corticosteroids (Group 1), 32 topical 2% Cyclosporin A (CsA) (Group 2) and 32 only artificial tears (Group 3). Mean time until resolution of the symptoms was lowest in Group 1 (9.5±4.9 days) and highest in Group 3 (13.3±4.2 days)(p: 0.001). OSDI scores at the first and third weeks were highest in Group 3 (52.4±16.4 and 32.3±13.0) and lowest in Group 1 (41.0±21.3 and 23.9±13.2)(p: 0.01 and p: 0.009). At day 21, percentage of the patients with subepthelial infiltrates was the highest in Group 3 (63.4%) and lowest in Group 1 (42.5%).ConclusionsThe symptoms were less severe and had a shorter duration with topical corticosteroids and CsA when compared with palliative therapy. Topical 2% CsA may inhibit development of corneal subepithelial infiltrates when used in the acute phase of infection, similar to corticosteroids.

Purpose: To evaluate the therapeutic effect of oral steroids given to patients younger than 3 years with epidemic keratoconjunctivitis (EKC) accompanied by severe eyelid edema and inflammatory ptosis, in whom eye drops were not feasible., Methods: This study included 9 patients treated for EKC in local clinics whose condition failed to improve due to severe eyelid swelling together with difficulties in application of eye drops and pseudomembrane removal. We analyzed the extent of eyelid swelling, corneal damage, follicles, chemosis, and pseudomembrane formation in these patients before and after oral corticosteroid therapy in collaboration with the pediatrics department., Results: After a mean of 1.8 ± 0.7 days of oral steroid treatment, eyelid edema, corneal damage, conjunctival injection, follicles, and chemosis improved in all patients., Conclusions: Oral steroids are an effective adjuvant treatment for EKC in patients younger than 3 years in whom eye drops could not be administered frequently due to severe eyelid edema.

Purpose: To describe the use of topical 0.03% tacrolimus in patients with symptomatic corneal subepithelial infiltrates (SEIs) secondary to adenoviral keratoconjunctivitis (AK) that were resistant to tapering of corticosteroid eye drops., Methods: This was a prospective, nonrandomized, noncomparative interventional case series that included consecutive patients treated with tacrolimus for resistant SEIs after AK. The patients had active SEIs and corrected distance visual acuity (CDVA) of 20/25 or worse when treatment was initiated. The recorded data included age, sex, CDVA, intraocular pressure, duration and intensity of symptoms, biomicroscopy findings, and duration of therapy. The treatment was considered successful if there was a reduction in SEIs, as well as CDVA stabilization or improvement. The treatment was considered unsuccessful if the patient could not tolerate tacrolimus or if there was an increase in SEIs., Results: Seven patients were included (10 eyes). The mean age was 36.7 ± 12.3 years. The mean duration of tacrolimus therapy was 8.8 ± 2.4 months, and the mean duration of follow-up was 13.6 ± 10.7 months. Treatment was successful in 8 eyes of 6 patients. One patient could not tolerate the medication. Statistically significant improvement in the CDVA was observed (from a mean of 0.29 to 0.07) (P = 0.001). No statistically significant changes in the intraocular pressure were observed (P = 0.574). SEI scores showed a significant reduction from 2.20 ± 0.92 to 0.25 ± 0.46 (P = 0.011). All patients who completed treatment had improvement in ocular symptoms., Conclusions: Topical 0.03% tacrolimus seemed to be an effective corticosteroid-sparing agent for the treatment of SEIs after AK.

Objective: To determine the safety and efficacy of topical 0.03% tacrolimus ointment treatment for subepithelial corneal infiltrates (SEIs)., Methods: This prospective non-controlled interventional case series included patients with SEIs who had been previously treated with topical corticosteroids with either no improvement or the medication being withdrawn due to associated intraocular pressure (IOP) elevation. The patients were treated with 0.03% tacrolimus ointment twice daily for 22 weeks (including a 1-month washout). The objective data were best-corrected Snellen visual acuity (BCVA), IOP, and full ocular examination results, including SEI severity and the Schirmer test. The subjective data were the patients' responses to a questionnaire at all follow-up visits., Results: The patients consisted of five males (45%) and six females (55%) (mean age 50 ± 11 years) who were followed up for an average of 22 weeks. The mean BCVA (logarithm of the minimum angle of resolution [logMAR]) before and after treatment was 0.34 ± 0.09 and 0.08 ± 0.04 respectively (p = 0.042). All the patients evidenced significant objective clinical improvement, and none had a severe degree of SEI at the end of the treatment. The patients reported considerable reduction in the severity of their symptoms (foreign body sensation, glare, etc.). Three patients were excluded due to side-effects (one had severe dizziness and discomfort), and their data were excluded from the study., Conclusion: Topical tacrolimus 0.03% is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have untoward side-effects from topical steroids.

Background: To evaluate the treatment with topical 0.05% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEI)., Methods: We reviewed 16 patients (22 eyes) before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate scores (CSIS), intraocular pressure (IOP) prior to treatment and the last follow-up visit., Results: Six males (37.5%) and 10 females (62.5%), mean age of 35.2 ± 16.6 years, were included. The patients' average topical CsA use duration was 5.1 ± 3.5 months (1 - 13 months). The average follow up time of the patients was 9.2 ± 4.7 months (4 - 22 months). One patient, although he didn't have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution) before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p=0.002), reduction of CSIS (p=0.002) and reduction of IOP (p<0.001) prior to treatment and the last follow-up visit. 18 eyes (81.9%) showed clinical improvement and 4 (18.1%) had decreased SEI which did not fully disappear during the treatment period. The eyes which reached CSIS score 0 (18 eyes) were treated with CsA for 1 - 13 months; while the eyes which had clinical improvement but had not CSIS score 0 (4 eyes) were decided to discontinue of CsA treatment in last follow-up visit. There were recurrences in 2 eyes 3 months after the treatment. Patients reported reduction in the severity of symptoms after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with topical 0.05% CsA treatment., Conclusions: Topical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.

Purpose: To describe the use of cyclosporine A (CSA) 1% eye drops for the treatment of symptomatic corneal subepithelial infiltrates (SEI) occurring as a sequelae of adenoviral keratoconjunctivitis (AK) that are resistant to tapering of corticosteroid eye drops., Methods: This is a retrospective case series of patients seen at 2 institutions who had symptomatic corneal SEI occurring after AK that was resistant to tapering of corticosteroid eye drops and who were subsequently treated with CSA 1%. Information gathered included basic demographic information (age and sex), involved eye(s), duration of symptoms, initial best spectacle-corrected visual acuity (BSCVA), type of corticosteroid used, clinical course, and best spectacle-corrected visual acuity at the last follow-up visit., Results: Twelve eyes of 7 patients had symptomatic SEI develop after AK that were responsive to corticosteroid eye drops but were resistant to tapering. After the initiation of CSA eye drops, the corticosteroid eye drops could be tapered, and all eyes could be maintained on CSA eye drops once per day or less. Mean follow-up time was 13.0 months (range, 4-28 months)., Conclusions: CSA eye drops may be an effective corticosteroid-sparing agent for the treatment of SEI after AK. The use of CSA in this setting warrants further study.

Purpose: To evaluate the treatment with topical 1% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEIs)., Methods: We retrospectively reviewed the records of 9 patients (12 eyes) before and after the treatment with CsA 1% eyedrops twice daily. All patients had been treated with topical corticosteroids previously without improvement or had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected Snellen visual acuity, intraocular pressure, number of medications in use, and evaluation of severity of SEIs (improved, stable, or worse). For their subjective evaluation, patients were asked to complete a questionnaire based on the last follow-up visit., Results: Five males (56%) and 4 females (44%), mean age of 47 +/- 13 years, were included. Mean follow-up on CsA was 13 +/- 7 months. The mean best-corrected Snellen visual acuity (logarithm of the minimum angle of resolution) before and after treatment was 0.42 +/- 0.40 and 21 +/- 0.28, respectively, with no statistically significant improvement. There was statistically significant reduction in the number of medications before and after treatment from 1.88 +/- 1.05 to 1.22 +/- 0.44, respectively (P = 0.049). Six patients (66%) showed clinical improvement, and 3 (34%) were stable during the treatment period. Patients reported statistically significant reduction in the severity of symptoms before and after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with CsA treatment., Conclusions: Topical CsA 1% is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have unwanted side effects from topical steroids.

Purpose: Presently, there is no U.S. Federal Drug Administration (FDA)-approved antiviral therapy for the treatment of adenoviral (Ad) ocular infections. The goal of the present study was to determine the antiviral efficacy of human immunoglobulin (Ig), a preparation of highly purified and concentrated immunoglobulin (IgG) antibodies isolated from a large pool of human plasma donors, in vitro and on acute Ad replication in the Ad5 New Zealand White (NZW) rabbit ocular model., Methods: The antiviral activity of human Ig against multiple wild-type and human ocular isolates of adenovirus serotypes was investigated in vitro by using neutralizing assays in different human epithelial cell lines. In vivo bilateral topical ocular toxicity and antiviral efficacy were evaluated with established Ad5/NZW rabbit ocular models. In vivo Ig antiviral results were compared with those obtained with topical 0.5% cidofovir and saline., Results: In three different epithelial cell lines,

Objective: To evaluate the efficacy of cidofovir 1% eyedrops with and without cyclosporin A 1% eyedrops as a treatment of acute adenoviral keratoconjunctivitis (AKC)., Design: Randomized, controlled trial., Participants: Thirty-four patients with acute adenoviral keratoconjunctivitis of recent onset., Methods: Patients were divided into 4 treatment groups: 1) cidofovir four times daily, 2) cidofovir 10 times daily, 3) cidofovir four times daily and cyclosporin A four times daily, and 4) sodium chloride four times daily (control). The diagnosis was confirmed by adenoviral polymerase chain reaction from conjunctival swabs. Duration of treatment was 21 days., Main Outcome Measures: Severity of conjunctival injection, conjunctival chemosis, punctate epithelial keratitis during the course of treatment, and presence and severity of corneal subepithelial infiltrates were evaluated by a clinical score. Duration until subjective improvement of symptoms was recorded., Results: The frequency of severe corneal opacities was lower with cidofovir (P = 0.048). Cidofovir was toxic locally to the skin of the eyelids and the conjunctiva in a dose-dependent manner. Symptoms of local toxicity were clinically similar to the signs of the initial viral inflammation. They first appeared 8 to 12 days after beginning of treatment and completely subsided 7 to 28 days after discontinuation of cidofovir. The outcome measures of local inflammation did not differ between the four treatment groups. Cyclosporin A did not alter the course of the infection., Conclusions: Cidofovir lowers the frequency of severe corneal opacities, but its clinical use 4 to 10 times daily at a 1% concentration is limited by local toxicity. Further clinical studies to find an efficacious yet tolerable dosage regimen of cidofovir, possibly using an improved pharmaceutical preparation, are required.

Objective: To evaluate the efficacy of 0.2% cidofovir eyedrops and 1% cyclosporine eyedrops administered 4 times daily (qid) to treat acute adenoviral keratoconjunctivitis., Methods: A randomized, controlled, double-masked study was conducted on 39 patients with acute adenoviral keratoconjunctivitis of recent onset. Patients were divided into 4 treatment groups: (1) cidofovir qid, (2) cyclosporine qid, (3) cidofovir + cyclosporine qid, and (4) sodium chloride qid (control). The diagnosis was confirmed using adenoviral polymerase chain reaction from conjunctival swabs. Duration of treatment was 21 days., Main Outcome Measures: Severity of conjunctival hyperemia, conjunctival chemosis, superficial punctate keratitis during treatment, and presence and severity of corneal subepithelial infiltrates were evaluated using a clinical score. Duration until subjective improvement of symptoms was recorded., Results: Subjective improvement of local symptoms was accelerated in the cyclosporine group. All other clinically relevant variables showed no statistically significant difference among the 4 treatment groups. Particularly, we did not find a difference in the frequency of corneal subepithelial infiltrates at the end of treatment., Conclusions: Use of cidofovir, cyclosporine, or both did not accelerate the improvement of clinical symptoms of acute adenoviral keratoconjunctivitis compared with the natural course of the infection as demonstrated by this pilot study. This might be because of the wide spectrum of the clinical course of the infection, low sensitivity to cidofovir, too low of a concentration of cidofovir, or early cessation of viral replication in the course of the infection. The effect of a higher concentration of topical cidofovir with and without cyclosporine requires investigation in a larger group of patients.

A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, Herpes simplex, adenovirus and Acanthamoeba as an inpatient. Polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live Escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.

Purpose: To report a patient with persistent subepithelial corneal opacities 18 months after adenoviral keratoconjunctivitis who underwent photorefractive keratectomy for the correction of myopia., Methods: Case report, review of medical literature, and slit-lamp photography., Results: The patient underwent photorefractive keratectomy in each eye, 1 week apart, with ablation of central corneal opacities and resultant best-corrected visual acuity of BE, 20/20. Symptomatic subepithelial stromal infiltrates recurred in the peripheral but not the central cornea of each eye 3 months after laser treatment., Conclusions: Photorefractive keratectomy was successful in the correction of myopia and prevented the recurrence of adenoviral subepithelial corneal infiltrates within the laser-treated central cornea.

Purpose: To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelated to a previous photorefractive keratectomy (PRK) for the correction of myopia., Methods: The patients are part of an Institutional Review Board-approved study of the safety and efficacy of PRK. Both patients underwent bilateral, nonsimultaneous corneal ablation based on preoperative spherical equivalent., Results: Seven months after PRK, the first patient sustained an alkali burn in one eye that caused severe corneal scarring and myopic regression. The other patient developed bilateral keratoconjunctivitis, more intense in the right eye (1 month after the operation) than in the left eye (4 months after the operation). This right eye subsequently developed diffuse scarring and loss of visual acuity., Conclusion: Patients who have undergone PRK may develop severe corneal scarring after relatively mild ocular traumas or infections.

Objective: To evaluate the antiviral activity of topical diclofenac sodium (Voltaren Ophthalmic) and ketorolac tromethamine (Acular) (2 nonsteroidal anti-inflammatory drugs [NSAIDs]) on adenoviral replication in vitro and in the adenovirus (Ad) 5 McEwen-New Zealand rabbit ocular model., Methods: The 50% inhibitory concentration of ketorolac and diclofenac and their respective preservative components were determined for common ocular adenoviral serotypes (Ad8, Ad19, Ad1, and Ad5). In a series of experiments, Ad5 McEwen-inoculated New Zealand rabbit eyes were treated topically 4 times daily for 18 days with either ketorolac, diclofenac, prednisolone acetate (Pred Forte), or control vehicle (Comfort Tears)., Main Outcome Measures: Outcome measures included serial ocular tear film titers and the formation of subepithelial immune corneal infiltrates., Results: In vitro, neither ketorolac nor diclofenac demonstrated significant inhibitory activity against Ad1, Ad5, Ad8, or Ad19. In the rabbit model, there were no statistically significant differences among ketorolac, diclofenac, and the control vehicle with respect to viral replication or the formation of subepithelial immune infiltrates. In contrast, 1% prednisolone prolonged viral shedding and inhibited immune infiltrates (P < .001 for both)., Conclusions: Our experimental study suggests that treatment of epidemic keratoconjunctivitis with topical NSAIDs may be a safer alternative than topical steroids. Only controlled clinical trials can determine whether topical NSAIDs can provide symptomatic relief and not interfere with normal viral clearance.

Adenoviruses often cause epidemic keratoconjunctivitis. The infection is highly contagious, often leads to corneal opacities, and is therefore to be timely diagnosed and properly treated. The authors propose a method for rapid diagnosis of adenovirus infection based on examination of a scraping off the conjunctiva by indirect immunofluorescence with polyvalent fluorescent rabbit serum and offer recommendations on the use of this method. Using this technique, adenovirus antigen was detected in 14 (61%) out of 23 patients with acute follicular conjunctivitis and in 19 (95%) out of 20 patients with keratoconjunctivitis. Despite clinical cure after antiviral therapy, the antigen persisted for 1 month in 22-30% patients and in some patients for 3 months (as a rule, it was in patients treated too late or ineffectively or after corticosteroids). That is why maintenance antivirus therapy is recommended for 2-3 months after clinical cure.

Background: To report a newly recognized cause of late onset of corneal haze following photorefractive keratectomy (PRK)., Methods: A 35-year old woman who underwent uneventful PRK and subsequently developed viral keratoconjunctivitis 1 year after treatment., Results: During resolution of the viral keratoconjunctivitis, the patient developed extensive central corneal subepithelial infiltrates and anterior stromal fibrosis in the PRK ablation zone. More than 1 year after the initial infection, the central subepithelial fibrosis persisted, complicated by myopic regression, central steep island on videokeratography, and loss of five lines of spectacle-corrected visual acuity. By the end of the second year after the infection, visual acuity had improved with disappearance of the central steep island on videokeratography. However, the myopic regression and subepithelial fibrosis remained., Conclusion: Patients who undergo PRK may be at greater risk of visual loss following viral keratoconjunctivitis secondary to persistent subepithelial infiltrates and/or stromal fibrosis within the PRK treatment zone.

Corneal subepithelial infiltrates are a known complication of adenoviral conjunctivitis. In this article, we present a case of a 32-year-old man who developed these classic infiltrates after a well-documented adenoviral conjunctivitis. What is unique about this case is that the infiltrates recurred 8 months later after an upper respiratory infection without any clinical or laboratory evidence of a viral conjunctivitis. The possible confounding variable of corticosteroid withdrawal being responsible for the recurrence is highly unlikely because he had not used topical corticosteroids for almost 4 months.

'Adenovirus keratoconjunctivitis' is a diagnosis commonly made in Eye Casualty Departments. There are no clinical features that allow identification of the serotype causing the infection. The changeable patterns of presentation and manifestation of the different serotypes and the capacity of adenovirus to mimic other viral or bacterial infections is an enigma. Adenovirus infections are usually self-limiting; permanent visual loss is very rare. The use of corticosteroids is generally limited to cases with severe symptoms such as glare and incapacitating blurring of vision. Corticosteroids will not alter the basic pathogenesis of the disease but will suppress inflammatory signs. The sub-epithelial lesions are an immunopathological phenomenon resulting from the interaction of viral antigen and antibody in the anterior stroma with the cornea acting as a 'blotter'. An effective antiviral remains elusive.

150 patients with adenovirus type 8 infection where treated at random, in a prospective study. Based upon a quantifiable conjunctivitis severity score we tried to find out where there are differences in treatment. The best results were seen using polyvinylpyrrolidone-iodine (Betaisodona) although it could not prevent totally subepithelial corneal infiltrates. The combination of exogenous interferon alpha with polyvinylpyrrolidone-iodo-drops or trifluorothymidine-drops was less successful. We could not show any prophylactic effect of interferon on uninflamed fellow eyes. Treatment with vasoconstrictor did not show any therapeutic or prophylactic potency. This group of patients must be seen as a control group and the results of effective therapy should significantly differ from the results in this group. Topical corticosteroids should be reserved for severe symptomatic cases and those with iritis and pseudomembranous conjunctivitis. Giving topical corticosteroids in combination with antibiotics we did not find any influence on the incidence of subepithelial keratitis or the number of corneal infiltrates. The mean duration of acute keratoconjunctivitis using this therapy was longer than the mean duration in the control group with vasoconstrictor.