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:
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.