Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

Labib, Bisant A; Minhas, Bhawanjot K; Chigbu, DeGaulle I

ependent. 35, 36 PVI has been shown to demonstrate virucidal reductions for ocular HAdV types 3, 4, 5, 7, and 8 at 1-5 mins and types 37, and 64 at 15-60 mins for various concentrations. 36 This may indicate that time of exposure, not concentration of PVI, to disinfection is critical and that virucidal activity for PVI at different concentrations may require temporal consideration when evaluating specific virus types. Though PVI has been tested in vitro, in animal models, and clinically for its use in disinfection and wound healing for many decades, the use of a PVI irrigation in-office for EKC remains off-label. 32 The theory behind in-office PVI irrigation is to reduce viral load on the ocular surface and to decrease viral shedding. A commonly implemented protocol in clinical practice involves anesthetizing the affected eye(s), then instilling a pre-irrigation NSAID drop, followed by four to five drops of 5% PVI solution. The patient then rolls his or her closed eye(s) for 60 s to maximize exposure (including swabbing of the eyelid margins), followed by lavage of the ocular surface with sterile saline irrigation solution ( Figure 1 ). Finally, Figure 1 Set up for in-office povidone-iodine irrigation. From left to right: nitrile gloves, topical anesthetic, topical NSAID, betadine, 5% solution, saline solution, and folded paper towel for saline rinse. a post-irrigation NSAID drop is instilled. Anecdotally, patients may report exasperation of their conjunctivitis symptoms for 12-24 hrs after this procedure; however, the overall risk/benefit consideration regularly tips the decision in favor of preforming PVI irrigation. 32 Interestingly, Cheung et al have indicated that multiple types of adenovirus can be involved in a single outbreak and as PVI has proven viricidal activity in multiple ocular types of HAdV, it would be sensible to consider PVI irrigation to decrease colonization of the ocular surface in this disease picture. 37 The most powerful tool in limiting the severity of adenoviral conjunctivitis outbreaks includes reduction of viral shedding and limiting contamination of objects, workspaces, and surfaces in public places to avoid horizontal transmission, as mentioned previously in this manuscript. 38 Gargling or flushing with PVI has been postulated as an effective measure in disrupting the transmission of respiratory viral spread. 39 Hence, PVI irrigation can be a powerful tool to help in the reduction of transmission of adenoviral keratoconjunctivitis.