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Epidemic Keratoconjunctivitis (EKC)

Last updated Sept. 8, 2018

Approved by: Maulik P. Purohit MD, MPH

Marco Mayer

Epidemic Keratoconjunctivitis (EKC) is an infectious disorder caused by a group of microorganisms called adenoviruses.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Adenoviral Conjunctivitis
  • EKC
  • Viral Keratoconjunctivitis

What is Epidemic Keratoconjunctivitis? (Definition/Background Information)

  • The cause factors for Conjunctivitis are many; however, Epidemic Keratoconjunctivitis (EKC) is an infectious disorder caused by a group of microorganisms called adenoviruses
  • Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
  • In Conjunctivitis the white part of the eye turns red or pink, and hence it is also known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision
  • Any incident of EKC in closed environments such as offices and schools, may result in a rapid spread of the infection among individuals who work/study there, like a local epidemic
  • The symptoms may last about a month, but they tend to clear on their own. Often symptomatic treatment with supportive care is provided, as no specific management measures exist

Who gets Epidemic Keratoconjunctivitis? (Age and Sex Distribution)

  • Individuals in any age group are vulnerable to Epidemic Keratoconjunctivitis, but adults in the 20-40 years age group are affected the most
  • Newborns may acquire the infection from their mothers
  • Both male and female genders are equally affected, and no racial or ethnic preference is observed

What are the Risk Factors for Epidemic Keratoconjunctivitis? (Predisposing Factors)

The risk factors for Epidemic Keratoconjunctivitis include:

  • Contact with a person affected by EKC, or the use of infected (shared) items
  • This epidemic spreads in offices, classrooms, day care  centers, crowded spaces, and hospitals
  • Presence of certain underlying conditions such as asthma and eczema

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Epidemic Keratoconjunctivitis? (Etiology)

  • A group of adenoviruses (type 8 & 19) are responsible for Epidemic Keratoconjunctivitis
  • The disorder is highly contagious and the infectious phase may last for 10-14 days, until the eye returns to normal color
  • The virus is transmitted through direct contact with items used by the infected individual, by touch (hand-to-eye route), use of shared spaces (like swimming pools), and through respiratory, nasal droplets
  • EKC may also be associated with other underlying diseases, such as common cold, measles, and flu

What are the Signs and Symptoms of Epidemic Keratoconjunctivitis?

Common signs and symptoms of Epidemic Keratoconjunctivitis, which may last for 2-3 weeks, are:

  • Itching and redness of the eye(s); this may begin in one eye and slowly progress to the other
  • Formation of crusts (usually seen in the morning, on waking-up). Sticky eyelids, which are difficult to keep open
  • Eye pain and inflammation; with gritty feeling of sand-like particles inside the eye
  • Continuous discharge of watery mucus from the eyes
  • Blurred vision, light sensitivity
  • Certain indications like fever, fatigue, tiredness, vomiting, diarrhea, sore throat, muscular pain, and other flu-like symptoms may precede EKC onset

How is Epidemic Keratoconjunctivitis Diagnosed?

Epidemic Keratoconjunctivitis is diagnosed using the following tools:

  • The ophthalmologist or physician performs an eye examination and evaluates the patient’s medical history
  • Slit lamp exam (if necessary), for a detailed study of the eye
  • Biochemical studies of conjunctival scrapings; polymerase chain reaction analysis to determine the cause of the conjunctivitis. Generally such testing is not routinely used because the infection has a rapid course and majority of cases recover completely, without any complications

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Epidemic Keratoconjunctivitis?

Complications from Epidemic Keratoconjunctivitis may arise, if there are secondary conditions. These include:

  • Prolonged discomfort
  • Corneal ulcer, scar
  • Damage to the eye, loss of vision (this is rare, and happens only if corneal involvement is observed)
  • Spread of infection to other body parts
  • Possibility of a bacterial infection occurring in addition to the viral infection (termed as ‘bacterial superimposed infections’)

How is Epidemic Keratoconjunctivitis Treated?

Treatment of Epidemic Keratoconjunctivitis is mainly supportive, and based on underlying health factors, if any. Some general management measures include:

  • In most cases, EKC spontaneously resolves by itself. Symptomatic treatment helps individuals by providing a measure of comfort. Antiviral drugs are generally not prescribed
  • Application of warm compress can help reduce discomfort
  • Clean the eye crusts carefully using soft and wet cotton wool
  • Use of lubricating drops may soothe the eyes, and are helpful if eyes remain dry
  • Topical corticosteroids are used, if iris and cornea are involved
  • Use of topical antibiotic ointment is recommended to prevent bacterial infections
  • Avoid the use of contact lens during this period; wear eye glasses instead
  • If symptoms affect the whole body, then systemic treatment is provided

How can Epidemic Keratoconjunctivitis be Prevented?

  • Epidemic Keratoconjunctivitis is a highly contagious adenoviral infection. It is best to keep away from work or school, if you suffer from the condition
  • Prevent spread of the condition by maintaining hygiene, washing hands regularly, avoiding sharing of pillows, towels, make-up, and by limiting physical contact
  • Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also, avoid touching or rubbing the eyes (this may be difficult when the affected individuals are very young children)
  • Stop or restrain yourself from smoking tobacco, or drinking alcohol
  • The condition is seasonal/periodic, and individuals may chronically contract EKC

What is the Prognosis of Epidemic Keratoconjunctivitis? (Outcomes/Resolutions)

  • Most cases of Epidemic Keratoconjunctivitis are self-limiting and have an excellent outcome with supportive management of the condition
  • If there are other underlying conditions that aggravate the infection; then certain complications may develop that would require an extended treatment course
  • EKC is a chronic infection and can recur, if conditions are conducive for its recurrence

Additional and Relevant Useful Information for Epidemic Keratoconjunctivitis:

  • Many alternatives, natural therapy, or home remedies are available to ease the discomfort of Epidemic Keratoconjunctivitis. However, such treatment methods are not a proven science and should not be substituted for a qualified healthcare provider’s medical advice

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 19, 2013
Last updated: Sept. 8, 2018