Publication Exclusive: Further examination of three important cornea health topics

I participated in the excellent Cornea Health Round Table organized and moderated by Terry Kim, MD, at OSN New York 2014. For those interested, OSN New York is held every fall and enjoys a great reputation for clinically useful information using a case study format. I will share a few more thoughts on the three core topics presented in the cover story: epidemic keratoconjunctivitis, toxic anterior segment syndrome and the MRSA/MRSE positive patient who is scheduled for cataract surgery.

As Jodi Luchs, MD, mentioned during the discussion, based on the experience of several clinical trials, the differential diagnosis of the red eye can be difficult, with many errors in diagnosis when clinical impressions are compared with definitive cultures and laboratory diagnostics. This is a potential problem because a misdiagnosed EKC patient can create an epidemic in an ophthalmologist’s office. It is wise for the front desk person to triage the patient with an acute red eye to a specific examination room. The patient with an acute red eye should not go room to room with multiple tests by multiple technicians because viral keratoconjunctivitis, especially EKC, is very contagious.

Useful clinical exam features pointing to a viral etiology include the history of a upper respiratory infection, a watery serous discharge rather than mucopurulent, a follicular conjunctival response rather than micropapillary, and the presence of a preauricular node. Still, the clinical differential diagnosis can be a challenge. The RPS Adeno Detector Plus is a useful test and has a 95% sensitivity and specificity. It is low cost and gives a rapid test outcome. If positive, I treat as viral conjunctivitis. Not all viral conjunctivitis is EKC, but I treat them as though they were. Because EKC is extremely contagious, patients need to be instructed to stay home from school or work for 2 weeks. This is a significant hardship, but an epidemic in a clinic or at a workplace is a disaster, and quarantines work, as we learned again in the Ebola epidemic.

Click here to read the publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, March 25, 2015.