Serious Eye Infections May be Adenovirus

Serious eye infections – may be adenovirus (can cause outbreaks and permanent eye damage)

Public Health has been alerted to approximately 10 cases of serious eye infection consistent with adenoviral keratoconjunctivitis in the last week in patients from Abbotsford, Chilliwack, and Hope. Cases have presented with prominent subconjunctival hemorrhage, perioribital swelling and/or erythema, and corneal changes consistent with keratitis. One patient developed symptoms about 7 days after exposure to a person with similar symptoms, an incubation period that fits with adenovirus.

Unfortunately, adenovirus keratoconjunctivitis can cause permanent visual deficits. It sometimes also causes explosive outbreaks that can involve health care settings and health care workers, unless scrupulous infection control practices are followed.

Clinical presentation: In general, viral conjunctivitis has an acute or subacute onset, minimal pain, and often a history of exposure to someone with similar symptoms. Pruritus is common and a clear, watery discharge is typical. Severe photophobia and foreign body sensation is more likely with adenovirus keratoconjunctivitis, especially with follicular conjunctivitis, particularly on the palpebral conjunctiva, and preauricular adenopathy. (Caveat: follicular conjunctivitis and preauricular adenopathy also occur with herpes simplex and Chlamydia.)

Differential diagnosis: The differential diagnosis of the seriously red eye includes bacterial infection (chlamydial, gonococcal and meningococcal infection are of special concern), other viruses (especially herpes simplex, for which corticosteroid drops are contraindicated), and other conditions such as iritis, uveitis, angle-closure glaucoma, ocular ischemic syndrome, and penetrating or perforating ocular injury.

Lab work: If you see a patient with possible adenoviral keratoconjunctivitis in the next week or so, please do a viral and a bacterial swab; we’ll let you know if the clinical suspicion of adenovirus is confirmed or not. An ophthalmologist should be consulted for all serious eye complaints.

Treatment of adenovirus keratoconjunctivitis is generally supportive, including moist compresses and artificial tears for comfort. Antibiotic drops are indicated only when bacterial co- or super-infection is suspected. Temporary leave of absence should be considered for patients who have active infection and who work with the public.

Prevention of transmission of adenovirus in the clinical setting includes thorough hand washing, using eye drops in individual or unit dose containers, disinfection of instrumentation (e.g., stethoscopes) and work surfaces, washing pillowcases, etc. Please ask patients to be very careful not to spread infection, especially if visiting hospitals or other care facilities.

Advice for patients with viral conjunctivitis:

• Wash hands or use hand sanitizer immediately after touching eyes or face.
• Do not share towels, facecloths, pillowcases, or anything else that touches the face or lips (lipstick, blush brushes, cups, bottles, toothbrushes, etc.) with anyone else.
• Throw out any soft contact lenses or makeup that has been used within 7 days of onset of symptoms and do not use contact lenses or make-up until 2-3 days after all eye symptoms are completely gone. 

After Hours Public Health Emergency Pager: 604-527-4806. Ask for the Medical Health Officer On-Call.