Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

Bisant A Labib, Bhawanjot K Minhas, DeGaulle I Chigbu Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USACorrespondence: DeGaulle I Chigbu Tel +1 215 991 4790Email dchigbu@salus.eduAbstract: Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, ac...

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Autores principales:	Labib BA, Minhas BK, Chigbu DI
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	human adenovirus adenoviral keratoconjunctivitis antivirals immunotherapy povidone-iodine viral dissemination Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/c843d397ab43478b8bdcc0ab0cf65596
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spelling	oai:doaj.org-article:c843d397ab43478b8bdcc0ab0cf655962021-12-02T11:40:08ZManagement of Adenoviral Keratoconjunctivitis: Challenges and Solutions1177-5483https://doaj.org/article/c843d397ab43478b8bdcc0ab0cf655962020-03-01T00:00:00Zhttps://www.dovepress.com/management-of-adenoviral-keratoconjunctivitis-challenges-and-solutions-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Bisant A Labib, Bhawanjot K Minhas, DeGaulle I Chigbu Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USACorrespondence: DeGaulle I Chigbu Tel +1 215 991 4790Email dchigbu@salus.eduAbstract: Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, anti-inflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.Keywords: human adenovirus, adenoviral keratoconjunctivitis, antivirals, immunotherapy, povidone-iodine, viral disseminationLabib BAMinhas BKChigbu DIDove Medical Pressarticlehuman adenovirusadenoviral keratoconjunctivitisantiviralsimmunotherapypovidone-iodineviral disseminationOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 837-852 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	human adenovirus adenoviral keratoconjunctivitis antivirals immunotherapy povidone-iodine viral dissemination Ophthalmology RE1-994
spellingShingle	human adenovirus adenoviral keratoconjunctivitis antivirals immunotherapy povidone-iodine viral dissemination Ophthalmology RE1-994 Labib BA Minhas BK Chigbu DI Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
description	Bisant A Labib, Bhawanjot K Minhas, DeGaulle I Chigbu Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USACorrespondence: DeGaulle I Chigbu Tel +1 215 991 4790Email dchigbu@salus.eduAbstract: Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, anti-inflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.Keywords: human adenovirus, adenoviral keratoconjunctivitis, antivirals, immunotherapy, povidone-iodine, viral dissemination
format	article
author	Labib BA Minhas BK Chigbu DI
author_facet	Labib BA Minhas BK Chigbu DI
author_sort	Labib BA
title	Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
title_short	Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
title_full	Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
title_fullStr	Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
title_full_unstemmed	Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions
title_sort	management of adenoviral keratoconjunctivitis: challenges and solutions
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/c843d397ab43478b8bdcc0ab0cf65596
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Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

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