KILLING THE ADENOVIRUS: A Medical Cure
We remain concerned that patients continue to suffer needlessly
with adenoviral infection (epidemic keratoconjunctivitis)
when a medical cure is readily available. While there is
no FDA-approved medicine with such an indication, we discovered
a few years ago that use of an FDA-approved “Betadine 5%
sterile ophthalmic prep solution” excellently serves this
purpose. The solution is readily available from numerous
ophthalmic supply houses, such as Wilson Ophthalmics (www.wilsonophthalmic.com)
and Cynacon/OcuSoft (www.ocusoft.com), and costs about $15
for a 30ml unit-dose container.
For perspective, surgeons scrub with 10% Betadine prior to
gloving for surgery. Note that they scrub for 30 to 60 seconds,
then rinse, dry, and glove, since the microbial kill rate is
rapid. Likewise, when we encounter a patient with moderate
to advanced EKC, we generally treat them via the following
protocol:
- Anesthetize the eye with 0.5% proparacaine
- Instill a drop or two of any topical NSAID
- Instill 3 to 4 drops of 5% Ophthalmic Prep Betadine Solution
- Have the patient gently close his/her eyes and roll the eyes
around to fully expose all the conjunctival surfaces.
- With the patient’s eye closed, use either your gloved finger
or a cotton swab moistened with Betadine, and rub along the
eyelid margins to eradicate any resident virus there.
- After 60 seconds, lavage the ocular tissues with any sterile
saline irrigation solution.
This being done, the viral load has been largely cleared from
the ocular tissues; however, the conjunctiva remains red and
injected as a result of pre-treatment, adenoviral-induced inflammation.
Therefore we always prescribe Lotemax to be used q.i.d. x 4
or 5 days to hasten tissue renormalization and enhance patient
comfort.
- We also instill a couple of drops of a topical NSAID in
the office prior to discharging the patient, just to maximize
patient comfort. Occasionally, a mild, transient SPK can
result from such treatment, and the NSAID is simply an
optional step to ensure patient comfort.
The development of sub-epithelial infiltrates has long been
taught to be a common aftermath of EKC. Such infiltrates result
from prolonged viral residence time, and also depends on the
pathogenicity of the particular adenoviral serotype involved.
Since this Betadine therapeutic protocol shortens the vial
residence time, the antigenic stimulus for sub-epithelial infiltrate
development remains sub-threshold, the cornea remains clear,
and patient care is further enhanced.
We hope all eye doctors will immediately embrace this therapeutic
modality, as it represents a major advance in helping patients
with adenoviral infection.
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