Treatment of Keratoconjunctivitis

Introduction to Keratoconjunctivitis Treatment

• The American Academy of Ophthalmology recommends that the treatment of keratoconjunctivitis must be tailored to the specific type, with discontinuation of contact lens wear being essential for contact lens-related cases, topical corticosteroids for inflammatory variants, and appropriate antibiotics for infectious forms 1, 2

Types of Keratoconjunctivitis and Their Treatments

• For Superior Limbic Keratoconjunctivitis (SLK), mild cases respond to treatment of concomitant dry eye syndrome with lubricants, mast-cell stabilizers, cyclosporine, soft contact lenses, and/or punctal occlusion 3
• Associated filamentary keratitis may respond to topical 10% acetylcysteine or hypertonic (5%) saline 3
• The American Academy of Ophthalmology suggests that persistent symptoms of SLK may require surgical intervention such as cautery (chemical or thermal) to tighten redundant conjunctiva or conjunctival resection 3, 4
• Investigate underlying thyroid dysfunction (present in up to 65% of SLK patients) with thyroid antibody tests 3, 4
• Inform patients that SLK is a chronic, recurrent condition that rarely decreases vision 3
• For contact lens-related keratoconjunctivitis, immediately discontinue contact lens wear until the cornea returns to normal 3, 5
• The American Academy of Ophthalmology recommends a brief (1-2 weeks) course of topical corticosteroids for mild to moderate cases of contact lens-related keratoconjunctivitis 3, 5
• Consider longer-term use of topical cyclosporine 0.05% for contact lens-related keratoconjunctivitis 3, 5
• At follow-up, review contact lens fit, type, and care regimen; consider non-preserved lens care systems, daily disposable lenses, high DK/T ratio material, and reduced wearing time 3, 5
• Consider alternatives to contact lenses (eyeglasses or refractive surgery) once resolved 3, 5
• Rule out Acanthamoeba keratitis if moderate or severe pain is present 2, 5
• For Giant Papillary Conjunctivitis (GPC), treatment involves modifying the causative entity (contact lenses, sutures, ocular prostheses) 3, 6
• For contact lens-related GPC: replace lenses more frequently, decrease wearing time, use preservative-free care systems, administer mast-cell stabilizing agents, refit lenses, switch to daily disposables, or change lens polymer 6, 2
• Treat associated abnormalities such as aqueous tear deficiency and meibomian gland dysfunction 6, 2
• Consider discontinuation of contact lens use with topical anti-inflammatory agents 6, 2
• Control vernal and atopic keratoconjunctivitis prior to any corneal cross-linking to decrease risk of sterile keratitis 3
• For medication-induced/preservative-induced keratoconjunctivitis, discontinue the responsible agent, which usually results in resolution over weeks to months 6, 2
• For severe inflammation, prescribe a brief course of topical corticosteroids, preferably with preservative-free formulations 6, 2
• Use nonpreserved artificial tears or low-dose topical corticosteroids 6
• Monitor for subepithelial fibrosis 6
• For rosacea conjunctivitis, treatment includes eyelid hygiene, warm compresses, systemic tetracyclines, topical corticosteroids and cyclosporine, topical metronidazole creams/ointment, mechanical thermal pulsations, and intense pulse light therapy 3, 4

Special Considerations

• Educate patients about proper hygiene to prevent transmission of viral conjunctivitis 1
• Counsel infected individuals to wash hands frequently, use separate towels and pillows, and avoid close contact with others during the contagious period (10-14 days from onset) 1
• Gonococcal conjunctivitis requires immediate systemic therapy as it is vision-threatening 1
• The frequency of follow-up visits depends on severity of disease presentation, etiology, and treatment 3, 2
• Follow-up should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 2
• If corticosteroids are prescribed, perform baseline and periodic measurement of intraocular pressure and pupillary dilation to evaluate for glaucoma and cataract 3, 2

Important Pitfalls to Avoid

• Avoid indiscriminate use of topical antibiotics or corticosteroids 1
• Be vigilant for chronic/recalcitrant conjunctivitis, which may indicate underlying malignancy, inflammatory condition, or chronic infection 1
• Do not resume contact lens wear too early before complete resolution 5
• Remember that viral conjunctivitis will not respond to antibacterial agents 1
• Consider that keratoconjunctivitis may be associated with systemic diseases requiring further investigation 1