Adenoviral conjunctivitis (Ad-CS) has never been so popular a topic as it is right now. With over 26 million viewers tuning in to watch the Olympics, Americans have watched Bob Costas’s unilateral conjunctivitis worsen, then become bilateral. His ocular condition prompted many commentators to remark, “Can’t someone help him?” Members of the RAPID (Reducing Adenoviral Patient-Infected Days ) research group, along with many other optometrists, sat helplessly staring at our television screens, wishing we could send him a bottle of Betadine! So why didn’t he get that treatment? Why aren’t more patients correctly diagnosed with Ad-CS and treated with Betadine?
Adenoviral conjunctivitis (Ad-CS), also known as “pink eye,” is one of the most common eye infections worldwide. Ad-CS is highly symptomatic, causing discomfort, tearing, lid swelling, photophobia, and decreased vision. Some 15%-35% of the patients develop subepithelial corneal infiltrates that can progress to permanent visual impairment. Because of the epidemic potential of some adenoviral serotypes, Ad-CS is a reportable condition in Germany and Japan.1,2 Outbreaks of viral conjunctivitis spare no nationality, age, gender, or social class.3-6 Patients with acute conjunctivitis typically present to a primary-care provider and are estimated to comprise as much as 2% of a general practitioner’s practice.7 Medical management of Ad-CS is estimated to cost $670 million annually with patients losing 5 or more days of work or school per infection.8
Ad-CS is more contagious than other forms of conjunctivitis (or even other viral conditions including herpes simplex virus or human immunodeficiency virus) partly due to the virus’s ability to remain infectious in the desiccated state for weeks at room temperature.9 Adenoviruses have no outer lipid bilayer and are highly resistant to disinfection.10 The virus is transmitted directly through droplets or smears of infected bodily fluids, primarily tears or respiratory secretions, and by fomites on towels, doorknobs, soap, counters, instruments, eye drops, and eyeglasses. The hands of nearly 50% of patients with Ad-CS presenting for care were culture positive.11 The period of contagion lasts about 3 weeks.1 Incubation period for Ad-CS is about 10 days (range 7-16 days) prior to the onset of symptoms. Symptoms typically persist for 7 to 28 days. Studies report that most eyes test negative with culture by 13 days after the onset of symptoms.12,13 The duration and severity of symptoms and complications differ among the more than 20 adenovirus serotypes associated with conjunctivitis; however, serotypes 8, 19, 37, and 53 are known to have the greatest epidemic potential.14