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

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

Unlike cases of epidemic hemorrhagic conjunctivitis, the process does not begin so acutely and is not accompanied by sharp pain sensations, which patients compare with the feeling they experience when a foreign body gets into the eye. Incubation lasts on average 10 days. Characteristic are swelling of the eyelids, hyperemia of the conjunctiva in combination with pronounced infiltration of the tissue of the lower transitional fold, lacrimal caruncle, semilunar fold, the appearance of many translucent gray follicles both in the transitional fold and on the semilunar fold and lacrimal caruncle, which resembles a trachomatous process. However, an ophthalmologist even with little experience is unlikely to make a diagnostic error in this case, knowing that trachoma never begins acutely and that with trachoma, follicular-type elements are concentrated mainly in the area of the upper anterior fold.

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

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

1. the stage of acute clinical manifestations, which lasts up to 5-7 days and ends with the disappearance of adenopathy without a trace;
2. the fading stage, during which, however, in a unilateral process, disease of the second eye may occur;
3. corneal lesion.

Keratitis develops in 2/3 of cases. It is superficial and is accompanied by decreased corneal sensitivity. Knowledge of typical clinical signs of keratitis allows the doctor to conduct differential diagnostics with other forms of viral conjunctivitis.

Keratitis is usually focal. It suddenly appears on the 2nd-3rd week of the conjunctival disease as a mass of grayish infiltrates. Initially, infiltrates appear in the cornea at the limbus, and then in more central areas. Their localization in the optical zone leads to a significant decrease in visual acuity (to 0.1-0.2 and below). Infiltrates are rounded and located in the superficial layers of the cornea. The peculiarity of this infiltration is that it is located in the stroma, without occupying the layers of the corneal epithelium. This is confirmed by the absence of fluorescein staining of the corneal surface. Stromal localization of infiltrates, which sometimes have a pronounced, so-called coin-shaped character, explains the fact of their long existence. Despite resorption therapy, months pass, and sometimes even 1-7 years, before the infiltration disappears and the previous visual acuity is restored.

Experience shows that in rare cases adenoviral conjunctivitis may begin with damage to the cornea. Characterizing acute epidemic adenoviral conjunctivitis in general, it should be said that in the group of viral conjunctivitis it is distinguished by the most severe and the longest and most persistent course (3-4 weeks). In some cases, the matter is not limited to the presence of conjunctivitis or keratitis. Adenoviral iridocyclitis may occur, characterized by symptoms characteristic of inflammation of the iris and ciliary body of the serous or fibrinous (plastic) type.

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