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A.L. Butt, J. Chodosh; The Epidemiology of Pink Eye: Endemic Keratoconjunctivitis? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4652.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Epidemic keratoconjunctivitis (EKC), caused by group D adenoviruses, is thought to be transmitted in epidemic fashion by eye care providers or between individuals living in close proximity. However, anecdotal evidence suggests that not all patients with EKC develop the infection in the context of an outbreak. We sought to test the hypothesis that EKC may be endemic in a general population. Methods: A retrospective study was performed of examination records from all patients seen with a diagnosis of viral conjunctivitis, follicular conjunctivitis, or epidemic conjunctivitis between December 1, 1995 and January 1, 2002 at Dean McGee Eye Institute (DMEI) clinics in the Oklahoma City area. Only patients with subepithelial corneal infiltrates and a documented history of acute follicular conjunctivitis were included in the study. Results: Over the 73 months of the study, 132,257 individual patients visited DMEI clinics in greater metropolitan Oklahoma City. Of these patients, 110 (0.08 %) were identified with the relevant diagnosis codes. Of these, 54 (49 %) met our inclusion criteria. Twenty six of 54 patients (48 %) had no recollection of exposure to anyone with pink eye or an upper respiratory infection. Based on clinical examinations, the mean duration of disease was 24 weeks, but the median was 5 weeks, reflecting a subset of patients with a prolonged course. Indeed, 14 of 54 (26 %) demonstrated chronic corneal inflammation defined by us as symptomatic subepithelial infiltrates lasting more than 45 days from the first examination, and required topical therapy with corticosteroids, non-steroidal anti-inflammatory agents, and/or cyclosporine. One patient was followed for symptomatic subepithelial infiltrates for 132 weeks, and is still under treatment. Annual case numbers ranged from 3 each in 1997 and 1998 to 25 cases in 2000, but with no more than 5 new cases in any single month, no seasonal predominance was evident. Importantly, the Oklahoma State Department of Health reported no outbreaks of conjunctivitis during the period of the study. Conclusions: If an epidemic is defined as the occurrence in a community or region of cases of an illness clearly in excess of normal expectancy, our study suggests that EKC can be considered endemic. The observation that symptomatic subepithelial corneal infiltrates became chronic in one-fourth of our patients suggests a greater level of long-term morbidity than previously appreciated. A prospective study of EKC would better define the natural history and viral and immunologic correlates of the disorder.
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