Epidemic keratoconjunctivitis is the most common type of infectious conjunctivitis, and is caused by adenoviruses. The mode of transmission is mainly through direct contact with ocular secretions. Epidemic keratoconjunctivitis is generally diagnosed based on a patient's clinical features, and additional measures, such as cell cultures, polymerase chain reaction, and rapid antigen detection tests, can further confirm the diagnosis. The most common symptoms include a foreign body sensation, tearing, and photophobia. The symptoms are usually expressed unilaterally in the initial phase, but gradually become bilateral. Frequently occurring complications include pseudomembrane formation and subepithelial infiltrates. Currently, no antiviral agent has been proven effective to alter the natural course of the disease, and treatment merely has a supportive role instead of a curative role. Therefore, preventive measures in medical offices and in the community are the most important methods of controlling the propagation of this disease.
Adenoviridae ; Adenovirus Infections, Human ; Cell Culture Techniques ; Conjunctivitis ; Conjunctivitis, Viral ; Diagnosis ; Foreign Bodies ; Humans ; Keratoconjunctivitis* ; Photophobia ; Polymerase Chain Reaction ; Sensation ; Tears

PURPOSE: Corneal perforation from phlyctenular keratoconjunctivitis is rarely reported worldwide and no case has been reported in Korea. We report a case of corneal perforation in a patient with phlyctenular keratoconjunctivitis along with a literature review. CASE SUMMARY: A 15-year-old female presented to our clinic with repetitive tears, conjunctival injection, and discomfort in her right eye for several months. Slit-lamp examination revealed oily plugs at the meibomian gland orifices with collarettes, conjunctival injection and a round, whitish elevated lesion accompanying neovascularization of the inferotemporal side of the cornea. As an initial treatment, topical antibiotic was given but no signs of improvement were observed. Hence, topical steroid was applied on suspicion of phlyctenular keratitis and the patient's symptoms and corneal lesion improved. Two months later, the patient's symptoms relapsed and the lesion was found progressing towards the central cornea. The treatment was restarted and the symptoms improved but the corneal lesion continuously progressed towards the center, thinning the central cornea. Seventeen months from the time of initial diagnosis, the patient revisited prior to the scheduled appointment complaining of abrupt tears in her right eye. Slit-lamp examination revealed a corneal perforation at the center of the thinned cornea. Hence, we performed an emergent tectonic corneal patch graft. After the operation, opacity remained covering the visual axis at the central cornea, thus penetrating keratoplasty was performed 10 months later. Henceforth, the patient has remained free of symptoms and visual acuity has been recovered. CONCLUSIONS: Usually phlyctenular keratoconjunctivitis responds well to treatment and does not have a significant influence on vision. However, occasionally phlyctenular keratoconjunctivitis may not respond to treatment and may spread to the central cornea causing loss of visual acuity and even corneal perforation in rare occasions. Therefore, in order to prevent such complications, prompt diagnosis and treatment are essential.
Adolescent ; Erlotinib Hydrochloride ; Blepharitis ; Cornea ; Corneal Perforation* ; Diagnosis ; Female ; Humans ; Keratitis* ; Keratoconjunctivitis ; Keratoplasty, Penetrating ; Korea ; Meibomian Glands ; Transplants ; Visual Acuity

This case report describes a case of self-inflicted chronic bacterial keratoconjunctivitis involving the patient's own semen. A 20-year-old male soldier was referred to our clinic for the evaluation of refractory chronic bacterial conjunctivitis. Over the previous 4 months, he had been treated for copious mucous discharge, conjunctival injection, and superficial punctate keratitis in both eyes at an army hospital and a local eye clinic. Despite the use of topical and systemic antibiotics according to the results of conjunctival swab culture, there was no improvement. During the repeated smear and culture of conjunctival swabs, surprisingly, a few sperm were detected on Gram staining, revealing that the condition was self-inflicted bacterial keratoconjunctivitis involving the patient's own semen. Thus, in cases of chronic keratoconjunctivitis that do not respond to appropriate antibiotic treatment, self-inflicted disease or malingering should be considered.
Chronic Disease ; Conjunctiva/*injuries/microbiology/pathology ; Cornea/microbiology/*pathology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*etiology/microbiology ; Eye Injuries/*complications/diagnosis ; Humans ; Keratoconjunctivitis/diagnosis/*etiology/microbiology ; Male ; Self Mutilation/*complications/diagnosis ; *Semen ; Young Adult

PURPOSE: To identify the long term clinical course of amblyopia and strabismus that developed secondary to a monocular corneal opacity following suspected epidemic keratoconjunctivitis (EKC) in infancy. METHODS: This was a retrospective study analyzing the medical records of seven patients, treated in our clinic, who were followed for more than five years. RESULTS: Four patients in our clinic underwent a corneal ulcer treatment following suspected EKC. Each developed a monocular corneal opacity. Three patients with a chief complaint of corneal opacity were transferred to our clinic from other clinics. These patients had documented histories of treatment for EKC in infancy. All patients were treated with early occlusion therapy, but amblyopia persisted in four patients. Furthermore, all patients had strabismus and showed a significant reduction of stereoscopic vision. CONCLUSIONS: Although infants with EKC are not always cooperative, slit lamp examination should be performed as early as possible, and appropriate medical treatment should be performed, thus reducing the development of corneal opacity. Careful follow up should be regularly performed, and the occurrence of amblyopia or strabismus should be verified at an early stage using visual acuity or ocular alignment examination. Ophthalmologic treatments, including active occlusion therapy, should also be pursued.
Adenoviridae Infections/*complications/diagnosis/epidemiology ; Amblyopia/*etiology/pathology/physiopathology ; Child ; Child, Preschool ; Corneal Opacity/*complications/pathology ; Disease Progression ; *Epidemics ; Eye Infections, Viral/*complications/diagnosis/epidemiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Keratoconjunctivitis/*complications/diagnosis/epidemiology ; Male ; Prognosis ; Refraction, Ocular ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Strabismus/*etiology/pathology/physiopathology ; Vision, Binocular ; Visual Acuity

Allergic conjunctivitis (AC) represents a spectrum of disorders, comprising seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC) and giant papillary conjunctivitis. Of these ocular allergy types, SAC and PAC are the most common. The most striking difference within this group of ocular diseases is that SAC and PAC remain self-limited without ocular surface damage, while AKC and VKC can compromise the cornea, causing ulcers and scarring and can ultimately lead to vision loss. Data on AC in the Asia Pacific is scarce however some understanding of prevalence of the condition has been obtained from the International Study of Asthma and Allergies in Childhood (ISAAC) studies and more recently from the Allergies in Asia Pacific study as well as some information from individual country surveys. Unfortunately none of this data has been collected using validated survey instruments specifically designed for AC. Surveys such as ISAAC have been predominantly concerned with respiratory allergic symptoms with questions added that incorporate some ocular symptoms. These questionnaires do not detect individuals who may have AC in the absence of allergic rhinitis. Using hospital ophthalmology outpatient populations for prevalence studies of ocular allergy immediately introduces a bias towards the more severe, complex forms of the condition as patients with the milder forms of SAR and PAR will rarely present to a hospital outpatient clinic. There is a real need for the development of validated questionnaires specifically addressing ocular allergy. There are no widely accessible studies examining prevalence of the complex forms of ocular allergy (AKC, VKC) in Asia Pacific region. This review will provide an overview of ocular allergy, its classification, clinical presentation and differential diagnosis, and will also discuss what is known about the epidemiology of ocular allergy in the Asian Pacific region.
Asia ; Asian Continental Ancestry Group ; Asthma ; Bias (Epidemiology) ; Cicatrix ; Classification ; Conjunctivitis, Allergic ; Cornea ; Cross-Sectional Studies ; Diagnosis, Differential ; Epidemiology ; Humans ; Hypersensitivity ; Keratoconjunctivitis ; Ophthalmology ; Outpatient Clinics, Hospital ; Outpatients ; Prevalence ; Rhinitis, Allergic ; Seasons ; Strikes, Employee ; Ulcer

Sjogren's syndrome is an autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia. Small-fiber neuropathy is rare, although neurological manifestations occur in as many as 30% of patients with Sjogren's syndrome. We report herein a patient with Sjogren's syndrome who presented with autonomic neuropathy and painful sensory neuropathy. Primary Sjogren's syndrome should be considered in the differential diagnosis of small-fiber neuropathy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Keratoconjunctivitis Sicca ; Neurologic Manifestations ; Sjogren's Syndrome ; Xerostomia

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.
Adult* ; Anti-Bacterial Agents ; Cefmenoxime ; Ceftriaxone ; Conjunctiva ; Conjunctivitis ; Cornea ; Diagnosis ; Follow-Up Studies ; Gonorrhea ; Humans ; Keratitis ; Keratoconjunctivitis* ; Male ; Neisseria ; Sex Workers

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.
Adult* ; Anti-Bacterial Agents ; Cefmenoxime ; Ceftriaxone ; Conjunctiva ; Conjunctivitis ; Cornea ; Diagnosis ; Follow-Up Studies ; Gonorrhea ; Humans ; Keratitis ; Keratoconjunctivitis* ; Male ; Neisseria ; Sex Workers

BACKGROUND: Long-standing atopic dermatitis patients frequently predispose to ocular complications. The ectodermal origin of the epidermis and of many eye structures explain the frequent associations observed in atopic dermatitis. OBJECTIVE: This study may help in evolving early diagnosis and in formulating standard therapeutic strategies to prevent and treat ocular complications by studying the types, frequency and dermatological characteristics of each ocular complication in atopic dermatitis. METHODS: We evaluated the ocular complications of 41 typical atopic dermatitis patients(26 males, 15 females) who had skin lesion around eyelids or complained of ocular symptoms. RESULTS: Mean age of the patients was 17.7 years. The onset of atopic dermatitis was during infancy in 21 patients, during childhood in 15 patients, and during adult in 5 patients and their mean duration of disease was 13.8 years. Mild ocular involvements including blepharitis in 29 patients(58 eyes, 70.7%), keratoconjunctivitis in 29 patients(58 eyes, 70.7%) were seen. More serious complications which may lead to decreased visual function including cataracts in 5 patients(10 eyes, 12.1%), retinal detachments in 3 patients(5 eyes, 6.0%) were seen. All the patients who had these two serious complications had facial dermatitis. And other ocular involvements including keratoconus in 2 patients(2 eyes, 2.4%), ocular herpes simplex in 1 patient(2 eyes, 2.4%), uveitis in 2 patients(2 eyes, 2.4%) were seen. CONCLUSION: It is important to perform an ophthalmologic examination in the early period of disease in long-standing atopic dermatitis patients especially those who have facial dermatitis for the early diagnosis and treatment of serious sight-threatening complications.
Adult ; Blepharitis ; Cataract ; Dermatitis ; Dermatitis, Atopic* ; Early Diagnosis ; Ectoderm ; Epidermis ; Eyelids ; Humans ; Keratitis, Herpetic ; Keratoconjunctivitis ; Keratoconus ; Male ; Retinal Detachment ; Skin ; Uveitis

Acute viral conjunctivitis was known as an infectious disease affected by various viruses and characterized seasonal variation, prevalent especially in summer. In Korea, the clinic loepidemiologic study of AVC was not conclusive. Therefore, further research should be conducted to improve the primary health care and the application of diffrential diagnosis and its therapy. Clinical symptoms and signs of 131 patients who was confirmed viral conjunctivitis among 237 patients was evaluated at the Chung-Ang University Hospital in 1987, 1989 and 1990. Along with physical examination, specimens from the conjunctival swab were cultured and isolated, and a sereologic test-Neutralizing test for enterovirus 70, and complement fixation test for adenovirus-was performed. As a result, acute hemorrhagic conjunctivitis was relatively epidemic in 1987 and 1990 (67.7 and 47.1 %), and epidemic keratoconjunctivitis in 1989 (91.8%).
Communicable Diseases ; Complement Fixation Tests ; Conjunctivitis, Acute Hemorrhagic ; Conjunctivitis, Viral* ; Diagnosis ; Enterovirus D, Human ; Humans ; Keratoconjunctivitis ; Korea ; Physical Examination ; Primary Health Care ; Seasons