Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

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

Human adenovirus (HAdV) is the most common cause of infection to the ocular surface, accounting for up to 75% of conjunctivitis cases. 1 The most common presentation is pharyngoconjunctival fever (PCF), which often occurs in children and manifests clinically with fever, pharyngitis, rhinitis, follicular conjunctivitis, and regional lymphoid hyperplasia. 2 Epidemic keratoconjunctivitis (EKC) is the most severe ocular form and is distinguished by its ability to invade the corneal epithelium, ranging in presentation from a keratitis to persistent and recurrent subepithelial infiltrates (SEIs). HAdV is highly contagious due to its unique structure and ability to evade the normal host's immune system. It is distinguished from other types of conjunctivitis in that it often involves the cornea, with potentially devastating visual complications. These features contribute to a heavy economic burden and necessitate the establishment of a standard treatment protocol. 1 In addition to the potential ocular manifestations of this virus, HAdV infections have the propensity to manifest systemically, in cases such as respiratory, urinary, and gastrointestinal tract (GIT) infections. This variety of presentations can infect a normal, healthy host, and also have an increased risk in immunocompromised individuals. Despite the detrimental effect that HAdV infections pose, there has yet to be an FDA-approved drug to treat these conditions, making management difficult. Even following the active phase of the disease, viral persistence and reactivation may occur. Oral and topical antivirals have been considered as offlabel management solutions, but problems with efficacy, bioavailability, and therapeutic profiles have limited their use. With regards to EKC, topical disinfection during active cases as well as treatment of corneal sequelae using corticosteroids and immunosuppressive agents show promise. This review will focus on how persistence and dissemination of HAdV poses 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.