Keratoconjunctivitis

Background

• Defined as concurrent inflammation of both the cornea and conjunctiva.

Keratoconjunctivitis Types

• Atopic keratoconjunctivitis
  • Common in patients with atopy (ie: eczema, allergies, asthma, rhinitis)
• Caustic keratoconjunctivitis
  • Secondary to chemical orbital exposure
• Epidemic keratoconjunctivitis
  • Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
• Ultraviolet keratitis
  • Secondary to UV light exposure
• Keratoconjunctivitis sicca
  • Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma

Clinical Features

Atopic keratoconjunctivitis.

• Intense itching
• Excessive tearing
• Burning sensation
• Clear mucus discharge
• Conjunctival erythema/hyperemia
• Blurred vision
• photophobia
• Foreign body sensation
• Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
• Chronic inflammation may eventually lead to vision loss

Differential Diagnosis

• Viral conjunctivitis
• Bacterial conjunctivitis
• Allergic conjunctivitis
• Acute angle closure glaucoma
• Uveitis
• Keratitis (eg: herpes keratitis)
• Corneal abrasion
• Trauma/Ocular foreign body
• Chemical exposure
• Dacryocystitis
• Reactive arthritis
• Cluster headache

Evaluation

• Generally a clinical diagnosis
• Fluorescein test followed by tonometry:
  • Fluorescein test if concerned for abrasions, corneal damage, foreign body, globe rupture
  • Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye

Management and Disposition

Based on likely etiology and severity:

Severity

• Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
• Moderate/Severe: should be referred to Ophthalmologist

Etiology

• Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist
• Epidemic keratoconjunctivitis: usually self-resolving
• Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
• Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist

See Also

• Caustic keratoconjunctivitis

References

• Hamrah, MD et.al. Atopic keratoconjunctivitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com
• Munoz, MD et.al. Diagnosis, treatment, and prevention of adenovirus infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com
• Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinallis emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education; 2016.