Keratoconjunctivitis

Background

Defined as concurrent inflammation of both the cornea and conjunctiva.

Keratoconjunctivitis Types

Atopic keratoconjunctivitis
- Common in patients with atopy (ie: eczema, allergies, asthma, rhinitis)
Caustic keratoconjunctivitis
- Secondary to chemical orbital exposure
Epidemic keratoconjunctivitis
- Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
Ultraviolet keratitis
- Secondary to UV light exposure
Keratoconjunctivitis sicca
- Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma

Clinical Features

Intense itching
Excessive tearing
Burning sensation
Clear mucus discharge
Conjunctival erythema/hyperemia
Blurred vision
photophobia
Foreign body sensation
Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
Chronic inflammation may eventually lead to vision loss

Differential Diagnosis

Evaluation

Generally a clinical diagnosis
Fluorescein test followed by tonometry:
- Fluorescein test if concerned for abrasions, corneal damage, foreign body, globe rupture
- Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye

Management and Disposition

Based on likely etiology and severity:

Severity:

Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
Moderate/Severe: should be referred to Ophthalmologist

Etiology:

Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist
Epidemic keratoconjunctivitis: usually self-resolving
Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist

References

Hamrah, MD et.al. Atopic keratoconjunctivitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Munoz, MD et.al. Diagnosis, treatment, and prevention of adenovirus infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinallis emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education; 2016.

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