Sameera Irfan.
Is Post-Adenoviral Keratitis Avoidable / Preventable?.
Ophthalmol Update Jan ;14(1):42-7.

Aim: To find out whether post-adenoviral keratitis can be prevented by any therapy and what is its appropriate management, once it has occurred. Materials & Methods: A prospective clinical study was conducted at a tertiary referral paediatric centre from March 2013 to June 2015. 220 consecutive cases of adenoviral conjunctivitis were included, between the ages 4 years to 36 years, (mean 15 years), with 95 females and 125 males. 114 cases presented with acute red eyes while 106 were chronic cases being treated elsewhere with topical antibiotics and steroids, but without any improvement. All 114 acute cases received artificial tears during the day, and a lubricant eye ointment at night. They were advised to avoid exposure to heat and sunlight, use ice-packs applied over closed eyelids at least 3-5 times during the day. They were reviewed on 3rd and 8th day after the start of therapy, and then weekly for 2 months. All treatment was stopped after 2 months. The 106 chronic cases were treated with Tacrolimus skin cream 0.03% twice a day applied in the lower conjunctival fornix and lubricating eye drops. They were examined weekly for 2 months and then monthly for 6 months. As the sub-epithelial infiltrates cleared up, the treatment was gradually tapered and discontinued after 4 months. Results: All 114 acute cases showed improvement on the 3rd day and all signs of conjunctivitis cleared up within 2 weeks in all cases (96.5% improvement) but 4developed sub-epithelial infiltrates which were treated with Tacrolimus. On further follow-up for 6 weeks, none developed post-adenoviral keratitis. The 106 chronic cases improved subjectively as well as objectively, after one week of therapy. After 3 weeks of therapy with Tacrolimus, infiltrates cleared up totally in all cases, 100% improvement. The treatment was continued for a further 2 months and no recurrences were noted for one month after stopping all therapy. No side effects of Tacrolimus were noted during this period. Conclusion: Acute cases can be effectively managed with only lubricant eye drops without the need for topical antibiotics and steroids, which are not only unnecessary but prolong this self-limiting disease and promote the formation of sub-epithelial infiltrates. The post-adenoviral keratitis can be effectively managed with Tacrolimus without any side effects.

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