Pharyngoconjunctival fever describes adenoviral conjunctivitis with the additional systemic symptoms of fever, sore throat, and headache. Patients with EKC may have photophobia and reduced vision long after resolution of the acute infection. While some argue that this is on a spectrum with simple follicular conjunctivitis, most clinicians use the term EKC when pseudomembranes are present, supeithelial corneal infiltrates develop, or corneal erosions are evident. When adenoviral eye infections further involve the cornea, the term epidemic keratoconjunctivitis (EKC) is used. A history of antecedent upper respiratory tract infection or close contact with someone with a "red eye" is common. Symptoms usually begin and predominate in one eye, and within a few days, have spread to the contralateral eye. Classically, preauricular lymphadenopathy can be palpated. There is usually a watery, mucoid discharge-morning crusting is a common complaint. Patients often complain of burning or gritty foreign body sensation. Occasionally, pinpoint subconjunctival hemorrhages may develop. This is seen clinically as conjunctival injection with folliculitis, especially on the inferior palpepral conjunctiva. Red and irritated conjunctiva is typical of the infection. Though symptoms may range in severity, a common constellation of signs and symptoms is frequently manifest. In the eye, adenovirus most commonly manifests as a follicular conjunctivitis.
There are over 40 serotypes of adenovirus in subgroups A-F. Adenovirus infection is also responsible for diarrhea in children, acute hemorrhagic cystitis, rashes, and rarely meningoencephalitis. During World War II, scores of soldiers in crowded environments and under stress developed acute respiratory disease (ARD), later found to be from adenovirus. In immunocompromised patients, the respiratory effects can be severe. Most commontly, adenovirus can cause a variety of respiratory infections from bronchitis, to croup, to pneumonia. There are multiple serotypes of adenovirus, and viral infection has a variety of clinical effects throughout the body. This patient presents with the classic signs and symptoms of conjunctivitis from Adenovirus. A large pre-auricular node can be palpated and visible on examination by studying the shadowing and elevation of the skin. Red eye (OS>OD) with crusting on the lashes.Ĭonjunctival injection with a follicular conjunctivitis.įigure 4: Lymphadenopathy. Palpable pre-auricular lymphadenopathy (LAD), L>R (see Figure 3).įigure 1: External Photographs.There is mild chemosis and palpebral edema, again L>R. A follicular reaction is evident on the palpebral conjunctiva, especially inferiorly, in both eyes (see Figure 2). The bulbar conjunctiva is injected OS>OD. Anterior segment: Evident crusting on lashes and watery d/c, OU.No eye surgery, trauma, nor contact lens use. PMH/FHx/POH: No previous ocular or health problems. Nne week prior to any ocular symptoms, patient had an upper respiratory infection which had subsided spontaneously. Symptoms did not remit with antibiotic drops and eye continued to worsen, with early redness and watery sensation in the contralateral eye as well. There was a mild "scratchy" sensation noted then. The eye gradually became increasingly red and irritated over the ensuing 2 days and the patient noted increased crusting in the mornings.
History of Present Illness: Adult patient presents with 6-day history of watery, irritated eyes noted that the left eye was tearing, slightly blurry, and starting to get red throughout prior to presentation.
Chief Complaint: Watery, red, irritated eyes left more than right
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