International Journal of Healthcare Sciences
ISSN 2348-5728 (Online) Vol. 8, Issue 1, pp: (153-157), Month: April 2020 - September 2020, Available at: www.researchpublish.com
Adenoviral keratitis and treatment in misdiagnosed patients: A follow-up report of the case series Dr. Vertika Kulshrestha Senior consultant ophthalmology, Sanjeevani Hospital, Singrauli Super Thermal Power Station, NTPC Ltd, India
Abstract: Keratitis is mostly caused by adenovirus infection to the eye. Superficial epithelial infiltrates (SEI) and superficial punctate keratitis (SPK) are pathognomonic for the diagnosis of adenoviral conjunctivitis. There are no specific diagnostic methods and treatments for adenoviral conjunctivitis which has resulted in its incorrect diagnosis and unnecessary antibiotic use. In our case series, study of 10 misdiagnosed patients, 70% suffering with diabetes mellitus healed after an accurate diagnosis of adenoviral keratitis and treatment within 4-6 weeks of regular follow-up. Eye ointment, eye drop, and combination medicines, which are used to relieve pain, can act as the appropriate treatment options for SEI and SPK.
1.
INTRODUCTION
Conjunctivitis is commonly known as a pink eye. It may be an infectious or non-infectious inflammation of the conjunctiva. The conjunctiva is a thin clear membrane that covers the anterior part of the sclera (bulbar conjunctiva) and covers the rear part of the eyelid (palpebral conjunctiva) [1]. Usually, the patient's symptoms, history, and inspection of the eyes, assist doctors in determining whether a bacterium, virus, or allergen is causing conjunctivitis. Eye redness or swelling, and discharge are the common clinical symptoms in conjunctivitis but symptoms may be variable depending on the etiology of infection. Viral conjunctivitis is the most prevalent type with 80% of the acute cases of conjunctivitis [2]. Keratitis or acute peribulbar infections are viral conjunctivitis cases mostly caused by adenovirus infection to the eye [3]. Keratitis mainly presents with symptoms such as unilateral itching, photalgia or photophobia, tearing, burning, and foreign body sensation [3]. On the surface of the cornea, tiny round vesicles appear which are filled with fluid and cellular debris. They are known as epithelial microcysts and are usually observed at the initial stages of keratitis. Anterior stromal infiltrates may be observed and persist from a few months to a year. Tabery HM reported cases with recurrent erosions and sterile anterior stromal infiltrates [4]. Superficial epithelial infiltrates (SEI) are considered as the important symptoms of keratoconjunctivitis. The presence of SEIs is considered pathognomonic for the diagnosis of adenoviral conjunctivitis. These infiltrates are typically observed within seven to ten days after the onset of the initial signs of infection [5]. According to a study by Oudova et al [6], superficial punctate keratitis (SPK) is mostly bilateral and might affect either eye. This disease was frequently misdiagnosed and treated incorrectly. The treatment by corticosteroids might curtail subjective symptoms but did not cure the disease [6]. Though there are a number of diagnostic methods for identification of viral keratitis such as viral culture, real-time polymerase chain reaction (RT-PCR), and detection of viral antigen, the widely accepted practice is initiation of treatment on clinical judgment [7-9].
2.
CASE PRESENTATION
We came across 10 misdiagnosed patients in the last 1 year which were included in the study. The patients were examined with torchlight and slit lamp. A slit-lamp provides a bright source of light and magnification to detect the character and severity of keratitis. Follicles can be observed in a variety of conditions, including inflammation caused by pathogens
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