Epidemic Keratoconjunctivitis (EKC)

Definition: inflammation of the cornea and conjunctiva caused by an adenovirus. It is named epidemic for the epidemic way the infection spreads.

Alternative names: pink eye, shipyard conjuntivitis, Sanders’ disease, Sanders-Hogan syndrome. Shipyard disease or shipyard eye, a form of EKC, occured during WWII. James Sanders, an English physician, was the first to describe EKC.

Symptoms: Sudden onset of irritated, red eyes. Discharge is watery. Photophobia with foreign body sensation is also noted. Vision changes could be mild (20/30) or severe with keratitis (20/100). Ocular symptoms usually calm down in two weeks.

Signs: Acute follicular conjunctivitis. Tender preauricular lymph nodes. The rule of eight applies. The first eight days, superficial punctate keratitis is present. The patient is contagious at this point. The second eight days, sub epithelial infiltrates are seen. The patient is not contagious.

Tests: The signs above can be seen by an eye doctor using a biomicroscope. Signs and symptoms provide the majority of clues to make a diagnosis.

Treatment: Hygiene is very important. Hand washing is must. Supportive therapy is important, such as sunglasses, artificial tears, cool compresses. The use of steroid is controversial. Steroid is generally used if sub epithelial infiltrates are greatly affecting visual acuity. The conjunctivitis may get worse before it gets better. The virus is shed in the tears. When sub epithelial infiltrates appear, the patient is non- contagious. Bedding and towels need to be wash frequently. The patient should not share towels with others.

Prognosis: The patient will recover with time. Remember, the conjunctivitis will probably get worse before it gets better. There is no effective antiviral medication.

Complications: Pseudomembrane may form and can be removed by an ophthalmologist.

Prevention: Avoid close contact with persons suffering from EKC. Do not share bedding or towels with infected individuals. Practice good hygiene, wash your hands.

54 Comments
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post by ddurk at July 6, 2010 All of you should be aware of a new treatment with 5% Betadine ophthalmic solution. As soon as you are diagnosed correctly, hopefully in the first week, a 60 second lavage with irrigation of saline, should kill the virus off very quickly. Then maybe a week of managing the inflammation, and you would be cured. Cases lasting more than a month I'd be suspicious of other organisms, such as Herpes Simplex or Zoster.
post by Jennifer from NC at May 7, 2010 I just wish this EKC would go away, I am having so much blurry vision! It affects my work and my everyday life! I have had it for over a month! I am beginning to wonder if I was misdiagnosed? It is fine when I wake up, then I go out into stores and my eyes go blurry and they are SO Dry! All they gave me was lubircant drops and night lubrication! I am so miserable!
post by ron moore from calgary alberta canada at April 23, 2010 an article by Melton/Thomas in the November 2008 Review of Optometry disussed the use of 5% Betadine to treat EKC. A subsequent article in the 2009 Review of Optometry Clinical Guide to Opthallmic Drugs sheds further light on this little understood condition.
post by Allison from USA at March 11, 2010 This virus is the worst!!! I am now on Lotemax for the 4th time my vision is fluctuating the glare from the infiltrates is horrible and every time I stop the steroid the infiltrates come back. I have been to the Optometrist, Ophthalmologist, the ENT and now a neurologist. It is most likely that the virus has caused some nerve damage b/c I have constant burning pain in my eye and hazy vision. I am extremely myopic and once the infiltrates clear I go back in my contacts but I can only stay in them 2 weeks b/c the symptoms of the virus return. I have read that the infiltrates can persist for months if not years so it looks like I am going to have to just live with it. This sucks!! I would not have wished this type of pain and problems on my worst enemy...I can't believe this is happening. I am 32 years old and have never even had Pinkeye before.
post by Britton from Florida, Treasure Coast at February 26, 2010 After seeing a forth specialist and suffering with this disease for 8 days, I was finally properly diagnosed with EKC, which I find ironic. How does an illness with the term "epidemic" in it's name be so difficult to identify?! I have never experinced pain like this and then after the fifth day and six different types of Rx eye drops I became legally blind or visually disabled, this lasted for 5 days. I thought I was having a reaction to one of the many steroids I was given but the Dr. insisted that this was not the case, diagnosed me with EKC and said it is the virus that cause the vision to blurr and gave me even stronger steroids. This forth round of steroidal drops after four days cleared up my vision enough to be able to return to work and barely drive. I am currently on day 15 and the scratchy eyes come and go and I thought my vision was close to normal yesterday and then it went blurry on me again. THe Dr gave me enough refills to last me 6 months and said to come back if I still needed more. I would've likely not contracted this horrible debiliating illness if my boyfriend got proper diagnosis and wasn't told that he would be fine in three days. If we knew it was EKC I would've stayed far far away. The Dr. said this is the second worse viral eye infection one could get after HSV1. There were times that I thought I would have shot myself if only I owned a gun...
post by Janice from Ontario, Canada at February 5, 2010 I was diagnosed with EKC in March of 2009. It has been almost a year. The swelling and redness decreased after prednisone drops. I was mostly cleared up and driving again after 6 weeks. Now after 9 months my eyes still don't feel normal. It always feels like there is mucus floating around. This morning I woke up with puffy eyes again and am fearing it is coming back. Fortunately my eye balls are white and hopefully I am just having an allergic reaction to makeup. That virus was the worst thing I ever encountered physically! I contracted it at my eye surgeons office. They apparently do not have to contact Public Health when there is an outbreak of EKC.
post by C Pennington from Oklahoma at January 9, 2010 I was diagnosed with EKC in 7/2009 in one eye the infection has long since cleared up but I keep getting infiltrates in my cornea which causes vision problems I just started my 4th round of steroid eye drops the infiltrates will clear up after a round of treatment but has always come back after I stop the drops. How long will this last?!!
post by Casey at December 9, 2009 I was diagnosed and I live in a really small town...i just happened to get lucky and have an AMAZING eye doctor... I am going on 7 days and the pain has definitely gone down...the eyelid swelling too...he put me on Cloaxin ( anitibiotic eye drops) because he thought it was just pink eye at first but told me to continue using them because they wouldnt hurt...he also put me on 1000 mg aday of Augmentin (potent antibiotic) because i have severe allergy issues and it was to help boost my immune system... he gives me two weeks until better
post by Tara from New Jersey at November 27, 2009 I was just diagnosed with ekc after seeing 2 other doctors prior. The first Dr. gave me antibiotics which made it worse, the second Dr. gave me 2 perscriptions, fml which is a steroid, i put this med in and my eye became extremely painful, i then had to follow it up with another script called veroptic which made my eye evne worse! It became even more inflammed and more painful. I was just seen by a 3rd Dr. a highly recommended specialist and he told me I have ekc and that eyedrops, no matter what they are will make the eye worse (which was so true!) He told me to go home get baby shampoo (no more tears) and wash the eye, with the eye closed then tissue dry it, twice a day. He also gave me Ocusoft lid scrub, to wash the eye lid. Do these 2 things twice a day, morning and evening and in 2 weeks it will be gone. I have this infection full blown and after doing what he said I already feel so much better. Good luck to anyone who has this, I don't wish this on my worse enemy. This is so painful. My Dr. also said it is rampant in NJ. You can get this from eye secretions and/or airborne, it's in the air so be very careful everyone and if you do get this DO NOT USE ANY ANTIBIOTIC/ANTINFLAMMATORY OR STERIOD drops as EYEDROPS will make it worse and trust me, I'm proof of that!
post by Mary from Dublin IRE at November 5, 2009 I am being treated for EKC for 13 months now. My husband got it too. I'm so fed up.I stopped the treatment in September and was clear for about one month and now its back again. I'm looking for a second opinion. My husband just stopped his medication in the summer and his hasn't returned.
post by maria k todd, mha phd from denver, co at September 21, 2009 I have this now, contracted in Korea touring hospitals there for work. The steroid made all the difference in the world. My symptoms escalated to 9/10 pain, with nausea and migraine. Preauricular lymph node involvement was dramatic along with nodes in the neck and chin. I was admitted for pain managmement and required parenteral narcotics and it didn't subside until they added the steroids. What a nightmare! I don't recommend this for a week off work. Find another excuse!
post by Marlana at September 16, 2009 I have been diagnosed with ekc but it's been over a month and my eye feels better. My doctor is saying i have to go 3 months without wearing my contacts which is almost impossible for me. I really feel like it's gone and i want to put my contacts back in. It is a miserable infection, i would hate to get it back.
post by gloria cohen from Israel at September 7, 2009 i was diagnosed with Keratoconjunctivitis 6 months ago in one eye & have been taking cortisone drops on & off since then.will my vision i one eye improve with time? How long?
post by SEHAM MOHAMMED from BAHRAIN at June 9, 2009 I HAVE BEEN DIAGNOSED WITH THIS DISEASE BUT IT LASTS FOR THREE MONTHS :( ??? AM IN SEVERE PAIN JUST LIKE A TOOTH ACHE
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