Just a brief presentation about Adenovirus affected the eyes.

1. Adenovirus
Presented by SEA Bunseng
First Year Resident
Khmer Soviet Friendship Hospital

2. Outline
I. Introduction
II. Pathogenesis
III. Clinical Manifestation
IV. Differential Diagnosis
V. Management

3. I. Introduction
Adenovirus are double stranded DNA virus surrounded by a non
enveloped polypetide icosahedral capsid with glycoprotein
projections.
There are 51 serotypes subdivided into 6 distinct subgroups (A-F),
which give specific clinical syndrome.
Most adenoviral eye disease presents clinically as one of the 3
classic syndromes:
Simple follicular conjunctivitis (multiple serotypes)
Pharyngoconjunctival fever (PCF; Serotype 3, 4 & 7)
Epidermic keratoconjunctivitis (EKC; Serotype 8,19 or 37,
Subgroup D)

4. II. Pathogenesis
Isolated in 1953 from surgically removed human adenoids
Adenovirus can cause a broad spectrum of diseases (URTI,
OSI, meningoencephalitis, acute hemorrhagic cystitis of young
boy, diarrhoea in children, Acute respiratory diseases of
children and military recuits etc)
The Virus can survive on dry surface and water for weeks.
Transmission via close contact with ocular or respiratory
secretions, fomites or contaminated swimming pools.
Infection could be sporadic or epidermic.

5. III. Clinical Manifestation
Pharyngoconjunctival fever
Most often affects school-aged children
Classic presentation: fever, sore throat, coryza and red eyes and
history of URTI.
Ocular symptom: slight itching and burning to marked irritation and
tearing, little photophobia, Swelling of lids (48h)
Ocular Sign: epiphora, conjunctival hyperemia and chemosis,
Subconjunctival hemorrhage, follciular or mild papillary conjunctival reaction
and eye lid edema, mild crusting of lid, serous discharge.

6. III. Clinical Manifestation

7. III. Clinical Manifestation
Epidemic Keratoconjunctivitis
Incubation period 2-14 days, person may remain infectious
for 10-14 days after symptom develop.
Preceded by flulike symptoms: fever, malaise, respiratory symptoms,
nausea, vomiting, diarrhea and myalgia.
Ocular symtoms: suden onset of irritation, soreness, red eye, photophobia,
foreign body sensation and excessive taring, ocular and periorbital pain and
decreased VA.
Ocular sign: Swelling and erythema of lid, Conjunctival hyperaemia,
Chemosis, Follciular reaction, papillary hypertrophy, subconjuctival and petechial
haemorrhage

8. III. Clinical Manifestation
Epidemic Keratoconjunctivitis
Ipsilateral preauricular lymphadenopathy is one of the classic findings of EKC
membranous and pseudomembranous conjunctivitis
Corneal involvement (mild and transient)
3-4 days after symptom onset in form of diffuse, fine epithelial keratitis that stains with fluorescein and rose
bengal. Persist 2-3 weeks
1 week after onset, focal epithelial keratitis may develop. Persist 1-2 weeks.
2 week after onset, sub epithelial infiltrates can appear beneath the focal epithelial lesions, persisting for weeks to
years, but resolve spontaneously without scarring.
rare cases, dicciform keratitis or anterior uveitis can occur.
no change in corneal sensation

9. III. Clinical Manifestation
Conjunctival membranes in a
patient with EKC
Subepithelial corneal infiltrates in a patient with EKC

10. III. Clinical Manifestation
stage 0: poorly staining, minute
punctate opacities within the
corneal epithelium.
Stage I: Fine punctate epithelial
keratitis (PEK)
Stage II: Fine and coarse PEK,
stains brightly with rose bengal.
Stage III: Coarse granular
infiltrates within deep epithelium,
early sub epithelial infiltrates,
diminished PEK
Stage IV: Classic sub epithelial
infiltrates without PEK
Stage V:: Punctate epithelial
granularity adjacent to and distinct
from the sub epithelial infiltrates.

11. IV. Differential Diagnosis
Acute haemorrhagic conjunctivitis
Herpes simplex virus
Systemic viral infections

12. V. Management
Spontatneous resolution occurs within 2-3 weeks.
Reduction of transmission risk
Topical Steroids
Other measures

13. References
✴Section 8, External Disease and Cornea. (2012-2013).
The American Association of Ophthalmology. page: 123-
127
✴Kenski, J. Jack. MD, (2011). Clinical Ophthalmology: A
Systemic Approach, 7th Edition. Elsevier Saunders, UK.
page: 195-197
✴http://emedicine.medscape.com/article/1192751-
overview
✴http://emedicine.medscape.com/article/211738-overview
✴http://emedicine.medscape.com/article/1192323-
overview