Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

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

Surgical management is usually not required in adenoviral keratoconjunctivitis; however, it may be necessary in cases of significant fibrotic remodeling of the conjunctiva or sustained corneal scarring with visual consequence. Membranes that develop on the mucosal surface can be differentiated into pseudomembranes or true membranes, with the latter being clinically distinguished by induced bleeding upon denuding. 1 Persistence of pseudomembrane can lead to subepithelial fibrosis of the conjunctival mucosa, symblepharon formation, and punctal occlusion. 1 Thus, rare cases may require repair of the fornix and associated lid anatomy defect (entropion or ectropion). Furthermore, streptococcal co-infection may be present in severe cases, with membranes that can precipitate corneal perforation and necessitate treatment. 95 For patients with chronic adenoviral corneal opacification following resolution of acute infection, phototherapeutic keratectomy (PTK) can be an alternative option to other corneal surgeries or transplants. Corneal transparency can be compromised, or corneal irregularity may result with sequelae from the immune response to pathogen. Fortuitously, these scars are often superficial in nature by virtue of affecting the subepithelial layer. Transepithelial PTK low dose mitomycin C has shown benefit in such cases with reported improvements in photophobia, best corrected vision, and contrast sensitivity. 96 Furthermore, a decrease in coma, secondary astigmatism, and total higher-order aberrations have been noted after PTK for SEIs in adenoviral keratoconjunctivitis. 97