Hyderabad Ophthalmologists' Association

Welcome, Guest
Username: Password: Remember me

TOPIC: adenoviral conjunctivitis

adenoviral conjunctivitis 5 years 9 months ago #53

we had a case of adenoviral conjunctivitis with severemult sub epithelial infiltrates since 1 month . he was started on steroids and lubricants. now he is on lotepred e/d OD since 2 weeks. still spk's are persisting. can we stop steroids.. till when should we continue. and can we start on cyclosporine..if yes then for how much duration.
The administrator has disabled public write access.
The following user(s) said Thank You: Dr. Anil Kumar Bathula

adenoviral conjunctivitis 5 years 9 months ago #55

Dear Doctor,
Thank you doctor for the mail, I am forwarding your query to the Cornea Expert and as soon we get the response,it will be on the website and also onto your email.
The administrator has disabled public write access.

adenoviral conjunctivitis 5 years 9 months ago #58

Dear Doctor,
The following is the response of the Dr.MS Sridhar Expert Panel Cornea :

Thanks Dr. Anil. Pls find below the response

Sub-epithelial infiltrates (SEIs) following adenoviral conjunctivitis affecting the vision, need topical steroid therapy. These lesions are because of host reaction to viral particles. When we start the steroid treatment, it is useful to record the visual acuity and count the number of SEIs, and draw them in slit and diffuse view. This will help us to know the response to treatment and also to know whether any new lesions have appeared.

Response to treatment can be assessed by the lesions fading, no new lesions and by improvement in vision.

In the given case , the response to treatment can be assessed by improvement in vision and also the nature of the lesions. If the edges of the lesions are becoming fussy, it means it is getting better. In case if you are not able to decide whether it is improving, consider recording the visual acuity now, note the number of lesions and edge of the lesions. Continue Lotepred for 1-2 weeks in a dosage of once daily.

Monitor IOP. If some lesions are present at the end of two weeks, you can switch over to a surface steroid like Flurometholone eye drops, 4 times a day for one week, 3 times a day for one week, two times for one week, one time for one week, one drop on alternate days for two weeks and one drop twice a week for two week.

I have tried 0.05% Cyclosporine eye drops twice a day for some patients , but not with remarkable improvement

Though these lesions at times looks scary, eventually it will fade away. We need to resist overindulging in topical steroid therapy. Call the patient frequently for IOP monitoring till you stop steroid therapy

Dr.M.S.Sridhar, MD
MAXIVISION
D.NO.1-118/24
PLOT NO.24
SURVEY NO.64
OPP.CYBERS TOWERS
HITECH CITY
MADHAPUR
HYDERABAD-500033
INDIA
PHONE:040-33681055
MOBILE:91-9849744286
WEBSITE: www.doctormssridhar.com
The administrator has disabled public write access.
The following user(s) said Thank You: Dr. Sree Lata V., Dr. Devadanam Simon Mitta

adenoviral conjunctivitis 5 years 9 months ago #59

I have several case of Adeno Viral Keratitis with sub epithelial precipitates which persist for several weeks to several months1
The use of steroids seems of no effect,taking their own time to clear these precipitates.
Ialso would like to know the role of Cyclosporines in these cases.
The administrator has disabled public write access.
The following user(s) said Thank You: Dr. Sree Lata V., Dr. Anil Kumar Bathula

adenoviral conjunctivitis 5 years 9 months ago #60

thank you very much for the reply sir.
the patient had grade 4 spk's (>15) in both eyes. more in periphery . vision was 6/9 OD, 6/18 OS -- improved to 6/6p OD, and 6/9 OS.
The administrator has disabled public write access.
The following user(s) said Thank You: Dr. Anil Kumar Bathula

adenoviral conjunctivitis 5 years 1 month ago #76

George Bernard Shaw had a problem choosing which patient to treat in his play “The Doctor’s Dilemma”, but yours truly is faced with a different dilemma: which line of treatment to choose for the unremitting stream of conjunctivitis in the OPD.
Virtually overnight onset of red eye, gross bulbar congestion, specially upper, cloudy tears, clumps of discharge, initially clear cornea; a week later 50% of cases showing signs of abatement, rest developing nummular keratitis, sub epithelial infiltrates, lasting upto 3 months. Life is miserable for these cases, as well as for the treating doctor.
Some develop a pseudomembrane especially on upper tarsal surface, the characteristic sign being epithelial erosions or filamentary keratitis at 12 o clock cornea.
I did a small study of conjunctival swab cultures (at my own expense) in a few “fresh” cases, i.e. those who had not put any drops purchased casually from their friendly local medical shop. Brief results below:
Day one or day two “un pre treated” cases:
growth E coli,
sensitive to Ciprofloxacin, Amikacin, Tobramycin, Ofloxacin.
Moderately sensitive to Norflox.
Resistant to Doxy, Genta, Cephalexin.

However, pseudomembrane cultures revealed Klebsiella,
Sensitive to Cipro, amikacin, tobra, genta, oflox, doxy, cephalexin;
Moderately sensitive to ampicillin
Resistant to amox, erythro,azithro cefixime.
Swabbing off the pseudo membrane under xylocaine topical analgesia dramatically reduces the intensity of the inflammation. Once, or occasionally, repeat after 3 or 4 days.
Initial purulent phase responds fairly well to one of these.
The problem however is the development of sub epithelial infiltrates in the second week. Dr CV Gopala Raju and Dr IV Rao have given a beautiful exposition of Epidemic Keratoconjunctiivitis in Journal of APOS Vol 2 Issue III 2013. Masterly inactivity as espoused in literature is not appreciated by anxious patients, and hence I am using antivirals Acyclovir eye oint for 3 or 4 weeks for want of any better ideas, and lubricants subsequently. Slow, painful recovery.
It will be useful to know the experience of those endowed with more grey matter than mine.
Sarveswara Rao Tekumalla
The administrator has disabled public write access.
 

Want To Check Your Membership?