Management of Subepithelial Infiltrates Following Adenoviral Conjunctivitis

Treatment Algorithm Based on Symptom Severity

For patients with subepithelial infiltrates causing visual symptoms after adenoviral conjunctivitis, the American Academy of Ophthalmology recommends initiating topical corticosteroids at the minimum effective dose, preferably using low-penetration agents like loteprednol or fluorometholone to minimize IOP elevation and cataract risk 1
Observation alone is sufficient for patients without visual symptoms, and artificial tears can be used for symptomatic relief, as suggested by the American Academy of Ophthalmology 1, 2, 3
The American Academy of Ophthalmology recommends initiating topical corticosteroids at the minimum effective dose for symptomatic cases, with preferred agents being loteprednol, fluorometholone, or rimexolone due to reduced risk of IOP elevation and cataract formation 1, 2, 3

The American Academy of Ophthalmology suggests that all patients on topical corticosteroids require regular follow-up, including interval history, visual acuity measurement, intraocular pressure monitoring, slit-lamp biomicroscopy, and pupillary dilation periodically to evaluate for cataract formation 1, 2, 3

The American Academy of Ophthalmology advises against confusing subepithelial infiltrates with HSV epithelial keratitis, where corticosteroids are contraindicated, and notes that subepithelial infiltrates occur 1+ weeks after adenoviral conjunctivitis onset 1, 2, 3, 4
The American Academy of Ophthalmology recommends avoiding premature discontinuation of corticosteroids, as this commonly leads to recurrence of infiltrates 1, 2, 3
Animal studies suggest prolonged viral shedding with corticosteroid use, though human data is lacking, as noted by the American Academy of Ophthalmology 1, 2, 3
The American Academy of Ophthalmology notes that recurrence risk exists after photorefractive keratectomy or LASIK in patients with prior adenoviral infection history 1, 2, 3

The American Academy of Ophthalmology recommends that if symptoms persist beyond 2-3 weeks without corticosteroid treatment, patients should return for evaluation 1, 2, 3
Patients on corticosteroids require more frequent monitoring based on treatment response and IOP measurements, as suggested by the American Academy of Ophthalmology 1, 2, 3