Adenoviral conjunctivitis

Adenoviral conjunctivitis classically presents as an acute follicular conjunctivitis.The infection usually is unilateral at onset but often becomes bilateral after several days. The second eye frequently is less severely involved than the first. Symptoms of adenoviral conjunctivitis include moderate foreign body sensation, tearing, and a watery to mucoid discharge. Patients often experience eyelid crusting, particularly on awakening. 

Figure 25-10 Palpation of preauricular node in patient with adenoviral conjunctivitis.

Most all cases of adenoviral conjunctivitis are diagnosed on the basis of a patient s signs and symptoms. Microbiologic investigation often is not needed, but adenoviral isolation via tissue culture can be achieved with conjunctival samples. A rapid immunochromatography test (RPS Adeno Detector, Rapid Pathogen Screening, Inc.)... 

Adenoviral conjunctivitis is a self-limited infection. Most cases resolve spontaneously over approximately... 

Use of povidone iodine has been advocated by some for the treatment of adenoviral conjunctivitis. The only controlled study of this treatment option demonstrated no significant effect of 1.25% povidone iodine administered four times daily on either days to resolution or proportion of cases resolved at 1 and 2 weeks. 

Topical nonsteroidal anti-inflammatory agents also do not appear to improve symptoms in adenoviral conjunctivitis. Topical ketorolac 0.5% used four times daily was shown to be no better than artificial tears at relieving the symptoms or signs of viral conjunctivitis and produced more stinging than artificial tears. 

The practitioner s office should follow proper recommended infection control procedures to prevent transmission of adenoviral conjunctivitis. Staff should carefully disinfect equipment, particularly tonometer tips, used in examining infected patients. Safe practice includes the use of barrier protection, such as gloves, while the practitioner examines patients with adenoviral conjunctivitis. Careful hand washing before and after patient examination is mandatory. 

Care must be taken to diagnose accurately any case of herpetic conjunctivitis. Herpetic conjimctivitis shares many of the clinical features of adenoviral conjunctivitis, and in the absence of recognizable corneal disease the two entities cannot easily be distinguished. Differentiation is particularly important if the practitioner contemplates using steroids as part of the management of adenoviral conjunctivitis, because the use of topical steroids exacerbates HSV infections. 

Sambursky R, Tauber S. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology 2006 113 1758-1764. 

Swisher S, Roth JA, Komaki R, et al. A phase II trial of adenoviral mediated p53 gene transfer (RPR/ INGN 201) in conjunction with radiation therapy in patients with localized non-small cell lung cancer (NSCLC). Am Soc Clin Oncol 2000 19 461a (abstract). 

Polymer-based artificial tears are the most common tear supplementation product used in dry eye treatment. In addition to dry eye, ocular lubricants are used in the treatment of corneal abrasions, ultraviolet keratitis, herpes simplex and zoster keratitis, phlyctenular disease, giant papillary conjunctivitis, superior limbic keratoconjimc-tivitis, vernal disease, adenoviral infections, and other ocular surfece conditions. 

Adenoviral infection is a common cause of acute follicular conjunctivitis. More than 45 immunologically distinct... 

Sterman D, Molnar-Kimber K, Iyengar T, et al. A pilot study for systemic corticosteroid administration in conjunction with intrapleural adenoviral vector administration in patients with malignant pleural mesothelioma. Cancer Gene Ther 2000 7 1511-1518. 

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