What causes EKC?

Epidemic keratoconjunctivitis (EKC) is caused by a virus called the adenovirus. Adenoviruses infect the outer layers surrounding the eye. EKC is transmitted through infected bodily fluids (tears or mucous secretions) that often enter an individual directly through direct contact with the eyes. EKC may be contagious just before full blown symptoms appear, and often remains contagious during the initial symptomatic period. This large time frame of being contagious allows the EKC virus to spread rapidly. Although community acquired EKC is known, one of the most common way of EKC spreading is through routine eye examination and eye doctors’ offices.

Even at room temperature, the EKC virus is able to live on most surfaces for weeks. EKC may still remain on a surface even after the use of 70% isopropyl alcohol which is one of the most common disinfectants utilized in eye care provider clinics. Alcohol alone is inadequate and may in fact give a false sense of cleanliness.

EKC facts

Epidemic keratoconjunctivitis (EKC) is a highly contagious viral infection of the eye.
EKC is caused by several strains of adenovirus, or the common cold virus.
There is no uniformly effective treatment, vaccine, or antiviral medication available for EKC.
A large number of people contract EKC from ophthalmologist or optometrist’s office after use of eye examination equipment, particularly eye pressure (glaucoma) checks.
It is very important for individuals infected with EKC to take hygienic measures.
EKC is now in a worldwide epidemic status.
EKC virus is not adequately disinfected by 70% isopropyl alcohol, which many eye clinics routinely use.
EKC can infect anyone, at any age.

How is EKC prevented?

Because EKC is very contagious, preventative measures are very important. As EKC is known to often spread through eye doctors and clinics (ophthalmologists and optometrists), the eye care professionals are the ones who must be the most urgent when taking preventative steps. Good hand hygiene is critical, such as washing hands and use of disposable gloves. Sterilization of all eye care equipment must follow the manufacturer’s instructions. Additionally, eye drops should not be shared among clinic patients such as dilation eye drops. It is paramount that individual eye drops are used whenever possible. When an EKC outbreak is reported at an eye healthcare location, the clinic must follow protocol, which may even mean for the clinic to temporarily shut down while it is cleared of EKC. The eye exam rooms and all equipment must be disinfected from “head to toe”. All eye drops must be discarded. Door handles and all affected surfaces must be cleaned with adequate disinfectant bleach.

Good hand hygiene
Use of disposable gloves
Single use eye drop
Follow manufacturer’s guidelines for sterilizing and disinfecting eye exam equipment
Disinfect equipment with sterilizer that is stronger that 70% isopropyl alcohol
Use medical grade disinfectant wipes like Cavi or Sani-wipes
Avoid use of multi-dose drops

Children who are infected with EKC are recommended to stay home until cleared by a doctor. For adults infected with EKC, it may be reasonable to go to work so long as they take strict preventative measures. Because there is no universally effective treatment or vaccine for EKC, it is extremely important for people with EKC to take preventative measures in order to stop the spread of infection to family, friends, and the community.

To prevent catching EKC, it is important to avoid touching your eyes and to wash your hands thoroughly if you do. Unless your hands are freshly washed, avoid touching other people. Be sure to wash any objects that come in contact with your eyes. Take steps to not share any items used on the eyes like makeup, towels, tissues, eye drops, contact lenses, glasses, and medications. If visiting an eye clinic or doctor, be sure to tell them if you have EKC, so that they can take preventative actions against spread. Since the EKC virus is very resistant to regular disinfectants like alcohol, medical grade disinfectants should be used to disinfect for EKC.

What are the symptoms of EKC?

Individuals will initially feel an irritating sensation in one or both eyes. This typically can start in the nasal corner of the eye and spread side ways along the eye. Individuals may start to complain of sensitivity to light, swelling, itching, tearing, blurred vision, and a clear or yellow discharge causing the eyelids to stick together. The symptoms may remain isolated to one eye, but will often spread to the other eye in two to seven days.

Swollen eyelids and painful red eyes
Itching
Tearing
Copious eye discharge
Light sensitivity
Blurred vision

Symptoms typically develop on average 6-11 days after exposure to the EKC virus. With EKC, the symptoms have a wide range of severity. Once the surface of the eye (called cornea) is affected, infiltrates appear along the eye that will resemble hazy dots, which may permanently reduce vision. Although acute symptoms typically heal within three to six weeks, many individuals may have symptoms for the better part of a year. Individuals who have been infected with EKC may continue to suffer from subepithelial infiltrates called SEIs for years. Symptoms often wax and wane. SEIs may act up or flare spontaneously, or possibly when an individual is stressed or ill.

Some individuals experience persistent dry-eyes for a long period of time, even after they have recovered from the acute phase of EKC. In these cases, the individuals may require medical treatment for severe dry eye. Some cases of EKC result in a marked drop in vision, possibly requiring steroid eye drops to be able to see properly. EKC may cause vision in some with 20/20 vision to suddenly drop to worse than 20/200 (indicating that someone sees 10x worse than the average person), thereby causing a siginificant disability in vision. Additionally, the treatment (steroid eye drops) may often lead to a dependency where affected individuals may be unable to easily stop using the steroids without recurring decrease in vision.