Epidemic Keratoconjunctivitis

EKC demonstrating subepithelial infiltrates in the anterior stroma.
  • The most common cause of "pink eye".
  • Self limiting disease.

Clinical Features

  • Very acute and highly infectious external eye infection caused by Adenovirus type 8 and 19.
  • The spectrum of the disease could be from mild and inapparent, to full blown cases.
  • Symptoms:
    • Foreign body sensation, photophobia, conjunctival hyperemic, eyelid stuck together in the morning, eyelid edema and sero-fibrinous discharge
    • Ocular symptoms commonly preceded by systemic symptoms of fever, sore throat and sometimes gastrointestinal disturbances


  • Acute onset of unilateral, followed by bilateral papillary and follicular reaction
  • Bilateral tender and enlarged preauricular lymph node
  • Diffuse epithelial punctate keratitis end erosions over the central cornea appear during the first or second week of the disease
  • The epithelial lesions gradually coalesce and form coarse spots of subepithelial infiltrates
  • These small-rounded subepithelial opacities may persist for weeks, months or even years
  • The first affected eye usually will suffer from relatively more prominent and prolonged keratitis than the fellow eye
  • Pseudomembrane formation may occur and can be complicated with conjunctival scarring and symblepharon
  •  The viruses can be readily spreaded by finger to eye contact, therefore hand washing and proper disinfection of instruments after contact with any patient suspected of having EKC are mandatory.


  • Symptomatic relief with artificial tears and systemic analgesic maybe required.
  • Topical corticosteroids and cycloplegic are useful in patients with marked iritis and central corneal subepithelial infiltrates