Acute epidemic adenoviral conjunctivitis: causes, symptoms, diagnosis, treatment

The epidemic situation, the mass character of the lesion, make it necessary to differentiate hemorrhagic conjunctivitis from another very widespread and well-studied disease - acute epidemic adenoviral conjunctivitis. In 1953, pathogens were isolated from the adenoid tissue of the human nasopharynx, causing various diseases (gastroenteritis, encephalitis, catarrh of the upper respiratory tract, pneumonia), as it became known later. Currently, about 40 different serotypes of human adenovirus are known . Many of them are related to eye pathology, transmitted by airborne droplets and by direct and indirect contacts (through a handkerchief, handshake, runny nose, coughing). According to epidemiologists, adenovirus infection in 40% of cases is combined with influenza and some other diseases. Acute epidemic adenoviral conjunctivitis is more often caused by adenovirus VIII of the serotype. This virus is very contagious, can retain virulent ability for several days, being in the air and in the liquid, especially at a lower temperature. The latter circumstance, possibly, determines the occurrence of epidemics of conjunctivitis more often in the colder seasons, during the period; temperature changes and high humidity.

Unlike cases of epidemic hemorrhagic conjunctivitis, the process does not begin so sharply and is not accompanied by sharp pain sensations, which patients are compared to the feeling they experience when they get into the eye of a foreign body. Incubation on average lasts 10 days. Characteristics of eyelid edema, conjunctival hyperemia combined with severe infiltration of the tissue of the lower transitional fold, teardrop, semilunar fold, the appearance of many translucent gray follicles, both in the transitional fold, and on the semilunar fold and lacrimal flesh that resembles the trachomatous process. However, an ophthalmologist, even with a small amount of experience, is unlikely to admit a diagnostic error, knowing that trachoma never begins acutely and that follicular-type elements focus mainly on the upper anterior fold in trachoma.

When differentiating from the trachomatous process, one should take into account the fact that the conjunctiva sometimes appears gray in the form of a film, especially in children, as well as the appearance of adenopathy from the side of the premaxillary and submandibular lymph nodes. Acute epidemic adenoviral conjunctivitis occurs with a small amount of detachable from the conjunctival cavity, which is serous-mucous in nature. If the second eye is involved in the process a little later, then on this eye all clinical symptoms are more pronounced, apparently due to the development of immunity to adenovirus VIII serotype.

The course of epidemic keratoconjunctivitis can be divided into three stages:

1. stage of acute clinical manifestations, which lasts up to 5-7 days and commences with the disappearance of adenopathy;
2. the stage of attenuation, during which, however, in a one-sided process, a second eye disease may occur;
3. defeat of the cornea.

In 2/3 of cases, keratitis develops. It is superficial, accompanied by a decrease in the sensitivity of the cornea. Knowledge of typical clinical signs of keratitis allows the doctor on their basis to conduct differential diagnosis with other forms of viral conjunctivitis.

Keratitis, as a rule, is focal. It suddenly appears on the 2-3rd week of conjunctival disease in the form of a mass of grayish infiltrates. Initially, infiltrates appear in the cornea near the limbus, and then in more central areas. Localization in the optical zone leads to a significant reduction in visual acuity (up to 0.1-0.2 and below). Infiltrates have a rounded shape and are located in the surface layers of the cornea. The peculiarity of this infiltration lies in the fact that it is in the stroma, without occupying the layers of the corneal epithelium. This is confirmed by the lack of coloring of the surface of the cornea with fluorescein. Stromal localization of infiltrates, which sometimes have a pronounced, so-called coin-like character, explains the fact of their long existence. Despite resorption therapy, months pass, and sometimes even 1-7 year, before infiltration disappears and the old visual acuity regains.

Experience shows that in rare cases adenoviral conjunctivitis can begin with a lesion of the cornea. Characterizing the acute epidemic adenoviral conjunctivitis as a whole, it should be noted that in the group of viral conjunctivitis it is characterized by the heaviest and longest and persistent course (3-4 weeks). In some cases, the matter is not limited to the presence of conjunctivitis or keratitis. Adenoviral iridocyclitis, characterized by symptoms typical of inflammation of the iris and a ciliary body of serous or fibrinous (plastic) type, may occur.

[1], [2], [3], [4], [5], [6], [7]