Acute Follicular Conjunctivitis Research Articles

Comparison of Treatment Outcome of Ganciclovir Ophthalmic Gel and Moxifloxacin Eye Drop in Acute Adenoviral Keratoconjunctivitis

Adenoviral ophthalmic infection is a self-limiting, highly contagious, very frequent infectious process. It can present in three acute clinical forms: nonspecific acute follicular conjunctivitis, pharyngo-conjunctival fever and epidemic keratoconjunctivitis. This study aims to assess and compare the efficacy of 0.15% ganciclovir gel with Moxifloxacin eye drop in the treatment of acute adenoviral keratoconjunctivitis.This longitudinal prospective study was conducted among 40 patients of acute adenoviral keratoconjuctivitis attending in the cornea clinic of National Institute of Ophthalmology & Hospital (NIOH), Dhaka, Bangladesh. They were randomly divided into two groups: group-I (study group) with 20 patients who used 0.15% ganciclovir gel and group-ii (control group) with 20 patients who used artificial tear and 0.5% moxifloxacin eye drop. Diagnosis was confirmed by expert cornea specialist by methodical ophthalmic examination. They were followed-up on 1,2,4 and 6 weekly. Mean score of symptoms and signs were calculated in every follow-up and compared between two groups. Unpaired t test and chi square test were done in applicable cases with statistical significance p<0.05. This study showed that in study group mean age of the respondents were 36.4±9.59 years and in control group 37±11.02 years. Most of them were male (82.5%). In study group, mean score of symptoms at the beginning of the study was 1.4. It was 1.14, 0.64, 0.20 and 0.04 after1,2,4,6 weeks respectively after starting treatment and in control group mean score of symptoms at the beginning of the study was 1.48. It was 1.46, 1.125,0.59 and 0.23 after1,2,4,6weeks respectively after starting treatment. A trend towards better response was observed in the treatment group and the difference was statically significant. The mean score of signs after starting treatment in group-iwas 1.8.It was 1.35, 0.775, 0.30 and 0.175 after ,2,4,6weeks respectively and in group-ii, mean score of signs at the beginning of the study was 1.675. It was 1.725,1.35,0.725 and 0.300 after 1,2,4,6 weeks respectively after starting treatment. A trend towards improved sings were observed in the study group and the difference was statistically significant at 1 week (p=0.0283), 2 week (p= 0.0003), 4 week (p=0.0016) except 6 week (p=0.1524). At 6th week of treatment improvement of signs occur but not statistically significant because of persistence of some corneal lesion. The significant symptomatic relief and clinical improvement was found in the study group treated with Ganciclovir ophthalmic gel suggesting an effective method for treatment of acute adenoviral keratoconjunctivitis. Mugda Med Coll J. 2024; 7(1): 9-13

Molecular, Epidemiological and Clinical Assessment of Adenoviral Keratoconjunctivitis in Egypt: Institutional Study.

To evaluate the frequency of Human adenovirus (HAdV) and its serotypes in keratoconjunctivitis patients who attended the outpatient clinics of Mansoura Ophthalmic Center, Egypt. Conjunctival secretions and corneal scrapings were collected from patients complaining of clinically diagnosed viral keratoconjunctivitis. The molecular method for HAdV detection was performed by polymerase chain reaction (PCR) followed by restriction enzymes (REA) determination of serotypes for hexone gene. HAdV infection was detected in 38% of samples. There were 4 serotypes of Human adenovirus species D (HAdV-D) isolated (4, 8, 37, 3), where HAdV-D8 was the most dominant. Contact with infected patient, follicular conjunctivitis and subepithelial corneal infiltrates are useful features for clinical diagnosis of adenoviral conjunctivitis. HAdV was significant etiological factor of acute follicular conjunctivitis. Accurate diagnosis of adenoviral conjunctivitis is essential for appropriate management, reducing permanent visual impairment and to limit the transmission of the virus within the community.

Assessment of corneal endothelial cell morphology and anterior segment parameters in COVID-19.

Background:The ocular manifestations of the 2019 novel coronavirus disease (COVID-19) vary from acute follicular, pseudomembranous, and hemorrhagic conjunctivitis to keratoconjunctivitis with subepithelial infiltrates and dendritic lesions. Similar to other respiratory viruses, such as adenoviruses, it is thought that COVID-19 may impact the cornea. However, its impact on the cornea and anterior segment parameters are currently poorly understood.Objective:This study aims to assess the corneal endothelial cell morphology and anterior segment parameters in patients who have recovered from COVID-19.Methods:In this cross-sectional study, the COVID-19 group comprised 34 patients who had been diagnosed with and recovered from COVID-19, while the control group comprised age- and sex-matched individuals without any systemic or ocular diseases. The endothelial cell density (ECD), coefficient of variation (CV) of cell area, hexagonal cell percentage (HEX), anterior chamber depth (ACD), central corneal thickness (CCT), horizontal anterior chamber diameter (HACD), iridocorneal angle (ICA), horizontal visible iris diameter (HVID), pupillary diameter (PD), and keratometry values (K1 and K2) were analyzed for each participant. The differences in each of these between the groups were analyzed using either an independent samples t test or a Mann–Whitney U test based on the normality of the data.Results:Regarding corneal endothelial cell morphology, the ECDs for the COVID-19 and control groups were 2278.50 ± 186.78 cells/mm2 and 2420.15 ± 222.25 cells/mm2, respectively (p = 0.002). A significant increase was noted in CV values in the COVID-19 group compared with the control group (p < 0.001). The HEX values for the COVID-19 and control groups were 56.26 ± 5.75 and 61.50 ± 3.63, respectively (p < 0.001). Regarding the anterior segment parameters, no significant differences were observed between the groups (p > 0.05).Conclusions:It was hypothesized that individuals who had recovered from COVID-19 would demonstrate a reduction in their endothelial functional preserves. A decrease in ECD and HEX and an increase in CV were observed in the individuals during their early post-recovery period from COVID-19.

Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up.

To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60–120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.

Outcomes of the Ophthalmic Examinations in Patients Infected by SARS-CoV-2

ABSTRACT Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection. Methods: In the present study, 50 patients with laboratory-confirmed SARS-CoV-2 infection, were enrolled. Ophthalmic examination with slit-lamp biomicroscopy was performed and the results were evaluated. Results: The mean age of 50 patients (24 females, 26 males) included in this study, was 58,26 ± 18,91 years. In nine patients, bilateral acute follicular conjunctivitis was present. In two patients, acute anterior uveitis was seen. Optic disc and macula were normal in all patients. Preauricular lymphadenopathy (LAP) was found in 6 (12%) patients. Of these six patients, five had follicular conjunctivitis, and one had anterior uveitis. Conclusion: Acute follicular conjunctivitis with preauricular LAP and anterior uveitis were detected and no fundus pathologies were found in detailed ophthalmic examination in patients with laboratory-confirmed SARS-CoV-2 virus infection.

Acute Onset of Bilateral Follicular Conjunctivitis in two Patients with Confirmed SARS-CoV-2 Infections

ABSTRACT Purpose To report bilateral follicular conjunctivitis in two confirmed Coronavirus (COVID-19) patients with the presence of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens. Participants and methods Two unrelated patients with confirmed SARS-CoV-2 infection and bilateral acute conjunctivitis were examined. Conjunctival swabs were assessed for the presence of SARS-CoV-2 by quantitative real-time polymerase chain reaction (RT-PCR) and viral culture. Results Both patients developed eye redness 3 days after the onset of COVID-19 symptoms. Slit lamp examination showed bilateral acute follicular conjunctivitis, which was resolved within 6 days. RT-PCR demonstrated the presence of viral RNA in conjunctival specimens from both eyes, which was unrelated to viral RNA from throat swabs. Conclusion SARS-CoV-2 may cause ocular manifestations such as viral conjunctivitis. Conjunctival sampling may be useful for infected patients with conjunctivitis and fever. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection.

Anterior Acute Uveitis Report in a SARS-CoV-2 Patient Managed with Adjunctive Topical Antiseptic Prophylaxis Preventing 2019-nCoV Spread Through the Ocular Surface Route.

PurposeTo report the clinical-epidemiological association between acute anterior uveitis and acute bilateral follicular conjunctivitis in a 30-year-old female patient who had tested positive for the SARS-CoV-2 RT-PCR.MethodsA 30-year-old female visited emergency ophthalmology care at the Siena Crosslinking Centre, Italy, for a bilateral eye redness lasting two weeks, associated with unilateral photophobia and blurred vision in her right eye. She visited on the 23rd of March 2020 in the full pandemic period and presented chills and fever with a temperature of 39.0°C, associated with complete loss of taste. Since eye examination findings, systemic symptoms and epidemiological criteria correlated with SARS-CoV-2 infection, she was referred to Siena University Hospital, Italy, for the SARS-CoV-2 nasopharyngeal buffer and haematological examinations for uveitis.ResultsEye examination revealed bilateral conjunctival hyperaemia with acute follicular conjunctivitis associated with right eye acute anterior uveitis characterized by diffuse pigmentary and whitish immune precipitates over the anterior capsule of the crystalline lens and initial anterior lens opacity explaining the blurred vision. Adjunctive prophylactic eye topical treatment, included in the acronym SHYPIO (0.02% sodium hypochlorite solution, 0.6% povidone iodine eye-drops and 10.50% ozonized oil eye-drops), was associated with conventional uveitis therapy to prevent the virus spread through the ocular surface route.ConclusionOur report demonstrates that complicated acute anterior uveitis (iridocyclitis) with blurred vision could be associated with SARS-CoV-2 infection, being potentially sight-threatening for early complicated lens opacity. Ophthalmologists examining suspected or asymptomatic patients should be aware of the risk of 2019-nCoV infection.

Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease

PurposeTo report the ocular characteristics and the presence of viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens in a patient with confirmed 2019 novel...

Diagnosis of acute follicular conjunctivitis: A 5-year retrospective analysis in a referral center

Objective and methodsA retrospective analysis was performed using the medical records in a referral center in Mexico over a period of 5 years, in order to determine the frequency of acute follicular conjunctivitis. Results and conclusionsA total of 859,986 ophthalmology consultations were given, from which 8,930 were diagnosed with acute follicular conjunctivitis (1.03% of the total). The number of patients diagnosed range between 100 and 200 in the majority of months. In August 2012 an increase was observed with 308 cases, and then decreasing after two months. This study did not demonstrate a highest frequency by month, with exception of year 2012 that showed a peak incidence in the third trimester.

Diagnóstico de conjuntivitis folicular aguda: un análisis retrospectivo de 5 años en un centro de referencia

Objective and methodsA retrospective analysis was performed using the medical records in a referral center in Mexico over a period of 5 years, in order to determine the frequency of acute follicular conjunctivitis. Results and conclusionsA total of 859,986 ophthalmology consultations were given, from which 8,930 were diagnosed with acute follicular conjunctivitis (1.03% of the total). The number of patients diagnosed range between 100 and 200 in the majority of months. In August 2012 an increase was observed with 308 cases, and then decreasing after two months. This study did not demonstrate a highest frequency by month, with exception of year 2012 that showed a peak incidence in the third trimester.

Ocular Chlamydia trachomatis in a tertiary hospital

Chlamydia trachomatis, a leading cause of blindness, remains hyperendemic in the poorer regions of the world. In Egypt, the disease represents a major health problem. The objective was to assess the active trachoma and actual ocular C.trachomatis infection as diagnosed by its isolation in the Vero cell line followed by its detection using Giemsa stain, iodine stain, enzyme-linked immunosorbent assay (ELISA) and Gen-Probe. Forty patients clinically diagnosed with chlamydial conjunctivitis were collected from the outpatient clinic of the Ophthalmology Centre, Mansoura University Hospital, Egypt. Two scrapings were taken, one fixed onto a slide for direct Giemsa stain and the other transported on sucrose phosphate medium to be cultured on the Vero cell line then identified by Giemsa and iodine stains, ELISA and Gen-Probe. C.trachomatis was detected by direct Giemsa stain in 1/40 (2.5%) of samples but isolated in the Vero cell line and identified in 4/40 samples (10%) by Giemsa and iodine stains or Gen-Probe. However, ELISA identified only 2/40 (5%) of total samples after culture. Direct Giemsa stain provided low sensitivity (25%) and a high specificity (100%) compared with cell cultures, with high statistically significant differences between both tests (P-value<0.001). All the indices for Gen-Probe in relation to Giemsa stain for chlamydial identification after culture were 100%. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and efficiency of chlamydial culture identification by ELISA as related to Giemsa stain identification were 50%, 100%, 100%, 94.7% and 95%, respectively, with high statistically significant differences between both tests (P-value<0.001). C. trachomatis was detected in a relatively high rate of acute follicular conjunctivitis patients as detected with culture on the Vero cell line. Identification of C. trachomatis in culture was 100% by Giemsa and iodine stains or Gen-Probe but only 50% by ELISA. Direct Giemsa stain demonstrated low sensitivity (25%) and high specificity (100%).

A randomised placebo-controlled trial of topical steroid in presumed viral conjunctivitis

AimsTo assess whether topical steroids improve patient comfort compared with hypromellose in acute presumed viral conjunctivitis.MethodsPatients presenting with acute follicular conjunctivitis, presumed viral in origin, were randomised to receive either...

Sarcoidosis presenting as acute bulbar follicular conjunctivitis

Sarcoidosis is a relatively uncommon multi‐systemic chronic granulomatous disease, which might affect any organ of the body, with the lungs, lymph nodes, skin and eyes most frequently involved.1–4 ...

医療従事者に生じたアデノウイルス結膜炎の3 例

We report three cases of acute conjunctivitis due to different types of human adenovirus (HAdV) in medical workers. Case 1: A 37-year-old man had epidemic keratoconjunctivitis and urethritis caused by human adenovirus type 37 (HAdV-37). Case 2: A 27-year-old woman had acute conjunctivitis due to human adenovirus type 15 (HAdV-15), Case 3:A 32-year-old woman had acute follicular conjunctivitis leading to a serotype of human adenovirus-53 serotype (HAdV-53). Note that HAdV-37 infection may cause keratoconjunctrivitis and urethritis. HAdV-15, -37, and -53 are important causative agents of nosocomial outbreak, and the application of a rapid diagnostic kit or PCR to a rapid diagnosis and proper infection-control measures can significantly reduce infection spread.

The Molecular Epidemiology of Ocular Chlamydia trachomatis Infections in Western Australia: Implications for Trachoma Control

We studied the serovar distribution of Chlamydia trachomatis in patients with clinical eye disease in Western Australia. Most disease occurred in indigenous communities and was caused by trachoma serovars Ba and C. Serovar Ba was genetically homogeneous throughout Western Australia and identical to strains previously described in indigenous communities in Northern Territory. This finding probably results from movement of these populations, and suggests that a widely coordinated, rather than local or regional, approach is needed to control trachoma in mobile populations. Serovar C strains within Western Australia were homogeneous but distinct from those in Northern Territory, possibly because of inherent differences in transmissibility or differences in population movements among communities carrying the different serovars. Genital serovars were occasional causes of eye diseases in infants, adolescents, and adults in trachoma-endemic areas. These serovars should be considered in the differential diagnosis of acute follicular conjunctivitis in these groups.

Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1

BACKGROUND/AIMSIt is reported by the national surveillance of ocular infectious diseases in Japan that 4.3% of cases of epidemic keratoconjunctivitis (EKC) diagnosed clinically were caused by herpes simplex virus (HSV)....

Genetic characterization of adenovirus strains isolated from patients with acute conjunctivitis in the city of S�o Paulo, Brazil

Genome analysis was carried out on adenovirus strains isolated from patients with acute follicular conjunctivitis in the city of São Paulo, Brazil. Eighteen conjunctival scrapings, collected between December 1993 and March 1994, were analyzed by two methods: a combination of polymerase chain reaction with restriction fragment length polymorphism and viral DNA restriction analysis, carried out using 10 restriction endonucleases: BamHI, BglI, BglII, HindIII, KpnI, SacI, SalI, SmaI, XbaI, and XhoI. Among 11 adenovirus detected by cell culture isolation, nine were Ad8, and two were Ad7. By restriction analysis the Ad8 isolates were typed as two new variants-Ad8/D11 (seven of nine samples) and Ad8/D12 (two of nine samples). Ad7 isolates were identified as a subtype of the widespread genome type Ad7b and the virulent type Ad7h, a predominant genome type circulating in Argentina, Chile, and Uruguay but absent in Brazil until 1991.

Acute follicular conjunctivitis caused by adenovirus type 34

PURPOSE: Adenovirus type 34 belongs to adenovirus subgenus B. The prototype virus of adenovirus 34 was isolated from a renal transplant recipient. However, no case of acute conjunctivitis caused by adenovirus 34 has been reported. Recently, we encountered two cases of acute follicular conjunctivitis in which adenovirus 34 was isolated. METHODS: The clinical isolates were identified by the standard neutralization test. The sequences of seven hypervariable regions in the hexon protein of these cases were compared with those of several prototype strains of adenovirus subgenus B. RESULTS: The cases were middle-aged, 34 and 41 years old, and male, and they exhibited moderate conjunctivitis with upper respiratory tract symptoms. Isolates from cell culture were identified as adenovirus 34 by NT. The mean homology rate (percentage of total number of coincident amino acids in the total length of amino acids in seven hypervariable regions) between clinical isolates and the adenovirus 34 prototype was 96.5%; in contrast, those between clinical isolates and the prototypes of adenovirus 11, adenovirus 14, and adenovirus 35 were 55.6%, 66.7%, and 57.9%, respectively. The results of conventional serotyping by neutralization test were confirmed by these values. CONCLUSIONS: These results indicate that adenovirus 34 may induce acute conjunctivitis in immunocompetent subjects and that special attention should be paid to adenovirus 34 as a causative agent for adenoviral conjunctivitis.

Conserved sequences in the fibers of epidemic keratoconjunctivitis associated human adenoviruses.

The fiber gene sequences of the human adenovirus types 19 and 37 were determined. The predicted polypeptides exposed a high homology. Ad8, Ad19, and Ad37 can cause epidemic keratoconjunctivitis (EKC), whereas Ad9 only infrequently causes acute follicular conjunctivitis. Comparison of the fiber knobs of Ad8, Ad9, Ad19, Ad37, and other previously published fiber sequences revealed that only two amino acid residues were conserved in the fiber knobs of Ad8, Ad19, and Ad37. Since the knob is responsible for interaction with the cell receptor, these two amino acid residues could play an important role in the pathogenicity of EKC causing adenoviruses.

Incidence of Adenoviral and Chlamydial Coinfection in Acute Follicular Conjunctivitis

After we studied a case of chlamydial and adenoviral coinfection in a 20-year-old woman, we determined the incidence of chlamydial infection in patients with acute adenoviral conjunctivitis. In a randomized retrospective study, we evaluated 100 specimens of patients with culture-proven adenoviral conjunctivitis. Three of 100 (3%) specimens tested positive for chlamydial DNA using polymerase chain reaction. Adenoviral and chlamydial coinfection is rare, yet should be considered in patients with prolonged follicular keratoconjunctivitis.