Introduction

Infectious keratoconjunctivitis is an inflammatory condition affecting the eyes, in particular the cornea and conjunctiva.¹ This is different from the more commonly heard of conjunctivitis, which only affects the conjunctiva.² Keratoconjunctivitis can be caused by a range of agents, such as bacteria and allergies, but when caused by a virus, this condition is known as infectious keratoconjunctivitis or epidemic keratoconjunctivitis. This is highly likely to spread between individuals, making it a contagious condition.⁴ This article will outline practices an individual can take to reduce their chances of getting infectious keratoconjunctivitis or spreading an existing infection to others. This is highly prevalent for those in busy environments such as schools and offices, as well as those caring for those suffering from infectious keratoconjunctivitis.⁴

What is Keratoconjunctivitis?

The word keratitis refers to inflammation of the cornea and conjunctivitis refers to inflammation of the conjunctiva.^2,5 These are both membranes on the outer surface of the eye involved in protecting the eye and enabling eyesight.¹ Epidemic keratoconjunctivitis has been shown to be linked to a particular virus called human adenovirus that causes this eye condition.⁶

An individual who is suffering from epidemic keratoconjunctivitis can experience a range of symptoms involving their eyes, which can last for between one to three weeks.⁴ This normally starts in one eye, which presents more symptoms, and then can also spread to the other.⁴ The eyes will appear red and swollen and cause pain, discomfort, or irritation.¹ The infected eye can also produce unusual liquids, such as a clear/yellow discharge or excess tears, causing watery eyes.¹ More severe symptoms include the eyes being sensitive to light or blurred vision.¹ The latter of these symptoms demonstrates the severity of this condition and therefore the importance of reducing the spread of this condition.

Routes of Keratoconjunctivitis Transmission

Epidemic keratoconjunctivitis can be caught through a range of methods and does not require direct contact with an infected individual.⁴ This is because the adenovirus that causes epidemic keratoconjunctivitis can travel in the form of small droplets of fluid and transmit infection through the nose, throat, and conjunctiva.⁴ Individuals can be infectious for between 10 to 14 days and transmit the infection from their hands and objects.⁴ There is also a 5-12 day incubation period, meaning someone can be infected but not present symptoms and be aware of their condition until 5-12 days later.⁴ This increases the chances of transmission as individuals are unaware of the precautions they should be taking.

The main transmission route of epidemic keratoconjunctivitis is infected individuals touching their eyes and then going on to touch other individuals or objects.¹ Sites that are common for epidemic keratoconjunctivitis transmission include tissues and door handles, as these commonly come into contact with the bodily fluids and infected hands.⁷ It is important for individuals to be cautious about minimising the spread of epidemic keratoconjunctivitis because of the fact there is no current treatment option.⁷

Hygiene Practices to Prevent Spreading Infectious Keratoconjunctivitis

Due to the highly infectious nature of keratoconjunctivitis, it is key that those suffering from this condition and those caring for the infected individual should uphold proper hygiene protocols.¹ These are easy practices that can sterilise infected surfaces and minimise the transmission of this condition.

Hand Hygiene

As a key route of transmission of epidemic keratoconjunctivitis, the hands should be regularly cleaned.¹ This is imperative to do after every time an infected individual touches their eyes, which can be a regular occurrence as epidemic keratoconjunctivitis can cause eye irritation.¹ Hand hygiene should also be followed by individuals who are around someone with epidemic keratoconjunctivitis, as they could have picked up viral particles on their hands from shared objects.

Hand hygiene routines include thorough hand washing with soap and water for a minimum of 20 seconds. The whole hand should be covered in this process, including between the fingers, the backs of the hands, the fingertips, the thumbs, and the palms. Washed hands should then be dried.

Hand sanitisers can be used for additional hygiene or convenience as they are a quick and accessible way to clean the hands. This involves applying a small amount of sanitiser onto the hands and rubbing it all over the skin's surface.

Disinfection

Given the fact that epidemic keratoconjunctivitis can be transmitted through infected surfaces, it is advised to regularly disinfect any potentially contaminated sites.⁷ Door handles are a common surface among different settings that should be cleaned if there is a known case of epidemic keratoconjunctivitis. In an office setting, the computer keyboard and phone handle are recommended to be cleaned.³ In a healthcare setting, such as an eye clinic, instruments should be cleaned after use.⁴ It should be noted, however, that adenoviruses are not susceptible to all cleaning agents and that a virucidal agent is advised for cleaning.⁷

Personal Items

Due to its highly contagious nature, anyone with an epidemic keratoconjunctivitis infection should not share any personal belongings with other individuals.³ This is because infected fluids could be contained on the surface of the item and infect an individual who uses them. Personal items that could be included are those that could have come into contact with the eyes. These are makeup products or tools, eye drops, towels, or pillowcases.³

Respiratory

Droplets of bodily fluid that are produced through coughing or sneezing will transmit adenovirus particles.³ Therefore, it is advised to limit droplet spreading from the respiratory system to surfaces and others. It may be necessary to wear a face mask to prevent the distribution of viral particles, especially in the presence of vulnerable individuals who could be immunocompromised.

Isolation Practices to Limit the Spread of Keratoconjunctivitis

Epidemic keratoconjunctivitis is a highly infectious disease that can last in an individual for two weeks.⁴ It can be difficult not to touch the infected eye due to its itchy symptoms and discharge.¹ This means it is highly likely to infect surfaces and other individuals, and therefore, it is advised for those with epidemic keratoconjunctivitis to limit their exposure to other individuals. It is encouraged to reduce contact in busy environments such as schools and workplaces.³ This also extends to other public spaces, especially those where there are individuals with weakened immune systems who would be more susceptible to the virus, such as hospitals or childcare facilities.³

Treatment

Epidemic keratoconjunctivitis can last for around two weeks and normally improves without treatment. There is no treatment for epidemic keratoconjunctivitis; however, there is a range of approaches that can be used to manage symptoms.⁷ These can include artificial tears and a cool compress to reduce irritation in the eye.³

FAQs

How can infectious keratoconjunctivitis be spread?

Keratoconjunctivitis is usually spread through infected hands and surfaces. Common sites that can contain infectious particles include door handles, pillowcases, towels, makeup items, and tissues.

What should you do to prevent spreading infectious keratoconjunctivitis to others?

Individuals with infectious keratoconjunctivitis should regularly wash their hands and disinfect surfaces. The individual should try not to touch the infected eye and dispose of any tissues that have been used to tend to the eye.

What should you do if someone in your household has infectious keratoconjunctivitis?

Do not share any personal items such as towels or makeup with someone with infectious keratoconjunctivitis.³ Regularly wash your hands and disinfect surfaces.

Summary

Epidemic keratoconjunctivitis is a highly infectious eye condition that causes inflammation of the surface of the eye, including the cornea and the conjunctiva. The eye will appear red, swollen, itchy, and may release discharge. It is normally caused by a viral infection known as adenovirus, which is highly contagious and can spread in the form of droplets. Infected hands and surfaces are the common routes of transmission of epidemic keratoconjunctivitis, and therefore, it is advised to practice good hand hygiene and surface disinfection procedures. Due to the highly contagious nature of this condition, it is recommended to avoid public spaces until the condition is resolved.