Tuesday, June 2, 2009

Treat EKC with Betadine

Treat EKC with Betadine
"EKC" or "epidemic keratoconjunctivitis" is contagious viral "pink eye". This is what the school nurse sends your child home from classes for (which may be silly b/c EKC has a 8 day latent period from exposure date to onset of symptoms). This is what all contact lens wearers with red eyes *think* they have, but the vast majority of them do not (they rather usually have infiltrative keratitis instead).

EKC has no treatment. Antibiotics are frequently and inappropriately and ineffectively Rx'd by the ER docs and the primary care docs and the pediatricians. Antibiotics don't work b/c they kill BACTERIA, and EKC is a VIRUS. Steroids (anti-inflammatories) in the absence of other treatment are specifically contraindicated b/c of the probability of "masking" the symptoms while actually promoting viral load increase.

We talk about EKC having "the rule of 8's":

- caused by adenovirus 8
- 8 day incubation or latent period between exposure and onset of symptoms
- symptoms usually last about 8 days in most cases

Traditionally there has been no treatment for EKC, which is a little weird to me b/c its one of the most common and most irritating/painful things that can happen to the human eye. I guess the reasoning is that in most cases it is relatively benign, is usually self-resolving with no long term effects, and doesn't usually last very long. Plus I bet adenovirus 8 mutates quickly just like the flu does, so treatment would have to change annually just like flu vaccines do. There are "anti-viral" eyedrops (trifluridine), but they are only effective against Herpes Simplex Virus (HSV), not adenovirus.

I have recently begun treating EKC with a one-time in-office 5% topical ophthalmic betadine solution application. Betadine quickly kills all viruses, but is not practical as an ophthalmic Rx medication b/c of its toxicity...it kills corneal epithelial cells too, and therefore needs to be "lavaged" or thoroughly rinsed out of the eye post-treatment. But the idea of the in-office treatment is to significantly knock down the viral load in the tear film and superficial corneal and conjunctival tissues leading to greatly sped recovery. I don't do this for every EKC case I see, only for the severe ones where the patient is very uncomfortable or has bad acuity from the stromal infiltrates, or when I think corneal scarring is inevitable. The treatment regimen is similar to the info on this site:

http://www.eyeupdate.com/pages/antiviral_drug.html

Except that I usually use some topical Voltaren (non-streoidal anti-inflammatory or NSAID) before and after the betadine application to minimize the probability of inflammation from the betadine toxicity.

This is not currently a common treatment in the optometric or ophthalmic world, but it is IMO a very effective one. It is recommended in the 2007 Clinical Guide to Ophthalmic Drugs.

21 comments:

  1. HELLO SIR,IAM AKBAR AGED 51 YRS HAVE DIABETES (CONTROLLED)ACTIVE AGILE ETC.
    I'V SITTING ON MY COMPUTORS FOR LONG HOURS...SO I DEVELOPED A KIND BLURRED CLEAR VISION IN MY LEFT EYE...HAS CATARACT ANYTHING TO DO WITH THIS..DURING SUNNY BRIGTNESS IT LOOKS WATERY LIKE SOME COATING IN FRONT OF RETINA..PL ADVISE FOR MY RECOVERY..TRHANK YOU...AKBAR

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  2. Are there any danges with betadine treatment? I thought betadine could cause blindness. my eye doctor wants to use it on my EKC but I am learly because he has never used it before!

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  3. jaaanbaz: cataract is certainly possible, but so are MANY other things: refractive error changes, retinopathy, etc etc. best to go see an eye doc about your blurred vision in your left eye.

    anonymous: it is highly unlikely for betadine to "blind" anyone. it can cause a mild corneal chemical burn if not rinsed out quickly & thoroughly, but even that would just be uncomfortable...it would not "blind" a person.

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  4. This makes no sense. An adenoviral-infected eye is a viral factory. It's not the "viral load" in the tear film that's causing symptoms, it's the repeated "explosion" of infected epithelial cells, each releasing new viral particles throughout the course of the infection.

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  5. uuuh, ok? just b/c you think it "makes no sense" to you.... doesn't make it a viable therapy:

    http://www.betadineforekc.com/Default.aspx

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  6. Hello,
    I had a betadine treatment in January 2010 and the virus seems to be back again. My Dr. says he wants to do another treatment (1 minute betadine, rinse, another minute w/ betadine, rinse), but it's soooo painful. Shouldn't that have killed the virus the first time? I would just hate to endure this pain again if this isn't the answer.

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  7. up to you, I guess. betadine kills adenovirus. so this is either a separate viral outbreak or it never was adenovirus. if its "back" - you can't expect 1 treatment to prevent all adenoviral outbreaks til the end of time. Jan 2010 was nearly an entire year ago. the average viral outbreak lasts 8 days...so this outbreak is not the "same" EKC viral infection "coming back".

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  8. Okay, well, I have the 'symptoms' of EKC and that's what my Dr. thinks it is, but I've had these symptoms for about 3-4 months... So do you think it could be something other than EKC, since it's clearly more than 8 days?

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  9. it *probably is* "something other than EKC". the question is, what? which is not going to be easy to answer.

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  10. Hi doc i hope you read this, well i had a chalazion or stye (can't tell, really, my doctor said it was a stye) that popped on its own 2-3 days ago. I have been washing it with soap and water, cleaning it every day. 2 days ago I have been cleaning the small wound (small dot where it "drained") with betadine antiseptic, im not sure if its healing well/quicker but i am concerned if this betadine antiseptic can cause blindness?
    i dont put it inside my eye but it might get in there a little..

    thank you and have a nice day

    annie

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  11. betadine cannot cause "blindness". it burns tho & is a corneal irritant so rinse it out if you get a bunch in there.

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  12. I have pink eye and work in a lab where we use betadine, so thought I'd try this. I made up a 5% solution with distilled water and put 4/5 drops in for 60 secs using a 1ml sterile syringe (without needle). Stings like hell but I washed them out at the eye station. It definitely helped. I also soaked my contact lenses in the 5% betadine solution, which I wouldn't recommend as they stain brown and don't destain too easily.

    Last time I had pink eye they were so itchy I went to A&E where they gave me some gentamicin eyedrops and a not so nice $50 co-pay. In future I will just stick with the 5% betadine. As princeidoc says though it's important to wash it out thoroughly as it burns and is not too good for the eye itself.

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  13. I would toss the contacts as the betadine has absorbed into the matrix of the polymer. Since betadine can irritate the cornea and it has been permanently absorbed into the lens, holding it for prolonged periods even in dilute amounts against the corneal epithelium poses the risk of irritating the corneal.

    Anonymous, O.D.

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  14. I'm currently treating an EKC pt. with Zirgan for the past few days. She's coming back in in two days. I might try adding the betadine. One thought - since betadine stings, placing a drop of tetracaine prior to the betadine should eliminate this side effect. We instill Betadine 5% eye drops in all our pre-op cataract patient's eyes, and never hear a complaint of pain, presumably because we also intill tetracaine as part of the pre-op regimen

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  15. I had viral pink eye and went to the dr and he opened betadine packets and dropped it in my eyes. He didn't mix it with anything and it hurt extremely bad! Then he gave me a steroid called Pred Forte and wrote on the Rx do not substitute. Well anyway, after that so called treatment happened my symptoms went away but now my farsightedness is blurry. Should I be concerned? What should I do next? I'm going back to the dr for a follow up but I'm not too happy with what he did! What's next for me?!

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  16. ok there is no need to "mix" the betadine. and many people Rx steroids afterwards, so that is appropriate. betadine cannot cause permanent damage so that is not the reason for your blurry vision. I am sorry you seem to be unhappy, but none of this sounds amiss to me

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  17. hi,
    I used betadine with a cotton pad soaked in water on my child's eye yesterday cos she had a pimple like large red spot on the inner corner of her eye. She touched hard and it sort of popped, I wanted to clean it with the cotton pad to avoid infection but some betadine leaked into her eye. We washed it a bit and most just continued to leak out. She woke up this morning with her eye looking much better. However, someone pointed out to me the risk of using betadine on the eyes. And I am feeling so bad for being stupid.
    But I would like to know how worried I should be at this stage? Should there be any more complications due to the use of betadine?

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  18. This comment has been removed by the author.

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  19. there is minimal "danger" of using betadine. it can irritate the eye, and will irritate it pretty good if you don't rinse it out. but it does not cause blindness or permanent damage. you did the right thing by rinsing it out. she's fine. you would already know by now if there was going to be a problem - if it "looks much better" today then she's fine.

    no worries. no "risk". good luck!

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  20. I developed EKC back in March about a week after an eye exam from my eye doctor. Was told there was a big outbreak of it in his office. Most recovered within a month. Here I am 6 months later with still having blurred vision and sometimes mucus in the eyes. Was on drops and a gel prescriptions forever. Is this unusual or can this still be EKC. Have read that sometimes EKC can take up to a year in rare cases. I really don't know what to do and am getting a little annoyed about this whole ordeal.

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  21. these are hard to answer. is it *POSSIBLE* that this is still EKC? yes, it's technically possible. is it "likely", tho? no, it's unlikely. it's statistically probable that it's *not* "still EKC". it's probably allergies causing the mucous. but since I am not looking at your eyes, I really don't know. so are you one of the "rare cases" that take "up to 1 year"?.......probably not. but possibly!

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