Decreased vision after conjunctivitis, Inflammation following pink eye - A State of Sight #121

Epidemic keratoconjunctivitis (EKC) is a severe type of conjunctivitis (pink eye) that can cause corneal inflammation. This usually occurs a week or two after the onset of the infection and may cause decreased vision.

Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care from Raleigh. Today, I would like to explain a type of corneal inflammation that can follow conjunctivitis (pink eye).

This can happen to patients who have had a severe case of conjunctivitis, medically known as EKC or Epidemic Keratoconjunctivitis. This is an infection caused by adenovirus, the same type of virus that can cause a common cold. As you may know, regular antibiotics do not have any effect against a virus. The virus is fought naturally by the body, so it takes time for the infection to resolve.

With EKC, the infection usually begins about 7 - 10 days after someone has been exposed to the virus. They may notice redness, tearing, irritation, itchiness, or sensitivity to light. Approximately a week or two after the infection has started, inflammation could occur in the cornea in some cases.

If you remember, the cornea is the clear shield that covers over the front of the eye. Underneath the front layers of the cornea, spots of inflammation can appear following EKC. These are areas where the body is reacting against parts of the virus that may still be present.

Our patients may notice pain, sensitivity to light, or decreased vision if this happens. Sometimes the problem can persist for a month or longer. This can be quite bothersome, especially when it interferes with vision.

When this inflammation is present, we have to make a decision with our patients if we want to treat with steroids or not. By using steroids, we can usually help vision improve by making the inflammation resolve more quickly, but the inflammation has a chance to return once we stop the steroids. Because of this, we usually try to judge how much it’s bothering our patients and how much it’s interfering with their vision to decide if they should consider the steroid treatment.

If only one eye is affected, the other eye has good vision, and the patient is comfortable, we may decide not to start the steroids. In these cases, we expect that the inflammation will resolve on its own, but it may take a month or longer. If we can wait it out without treatment, there is a better chance that it will not recur.

Alternatively, people who need good vision in both eyes or those who need their vision to improve more quickly may have to use steroids. As they improve, we have to taper and stop the steroids and monitor them to ensure that the inflammation stays away.

If you have any questions about this problem or if you have had severe conjunctivitis and aren’t seeing well, please post we will be happy to answer your them. I hope to see you again next time on A State of Sight.