Atlas of Ophthalmology

Epidemic Keratoconjunctivitis (EKC) with Nummular Infiltrates (Colour Image, Slit Lamp)

Córnea -> Queratitis, Keratouveitis -> Queratitis Intersticial y Estromal -> Queratitis Viral
Patient: 42-year-old female patient, BCVA 1/20 at OD, 0.5 at OS. Ocular medical history: OD amblyopia, OD/OS primary open angle glaucoma, since 7 years local therapy with prostaglandin derivates, BCVA decreased from 0.1 to 1/20 at OD, from 1.0 to 0.5 at OS. General medical history: empty Main complaint: severe vision loss Purpose: to present typical corneal signs of epidemic keratoconjunctivitis (EKC) Methods: ophthalmoscopy, slit lamp. Findings: (1) Color photography: confluent nummuli. (2) Slit lamp: infiltrates in corneal epithelium and subepithelium. Discussion: Epidemic keratoconjunctivitis is a highly contagious infection caused by adenovirus types 8, 19, and 37. The formation of subepithelial nummular infiltrates may lead to permanent visual disturbance. These infiltrates consist histopathologically of an accumulation of lymphocytes, histiocytes, and fibroblasts. The reasons for the persistence of these nummular infiltrates are not fully understood. It was reported (1) that nummuli can be identified as areas with an accumulation of dendritic cells (Langerhans cells) as well as punctiform structures located in the basal cell layer and in the region of the subepithelial nerve plexus. Steroid therapy for persistent or recurrent nummular adenoviral keratoconjunctivitis has little benefit because of the frequent recurrences, and mostly "offers" only serious steroid side effects. Reinhard et al. (2) reported that topical CSA 2% 1-4 times daily is about as effective as topical steroids in the symptomatic treatment of non-scarred nummuli after epidemic keratoconjunctivitis without the serious steroid side effects. Topical CSA treatment of nummuli after epidemic keratoconjunctivitis seems to be a recommendable alternative for the potentially dangerous steroid therapy. Literature: (1) Knappe S, Stave J, Guthoff RF. Epidemic keratoconjunctivitis. In vivo images of corneal structures with the confocal Rostocker laser scanning microscope (RLSM)]. Ophthalmologe. 2005 Aug;102(8):798-801. (2) Reinhard T, Sundmacher R. Local cyclosporin A therapy of nummuli after epidemic keratoconjunctivitis--case report. Klin Monbl Augenheilkd.1997 Mar;210(3):165-8.

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