Of the red eyes I see, epidemic keratoconjunctivitis (EKC) eyes are usually the most red. See Figure 1. There is often a history of a recent upper respiratory infection or contact with someone else who has it. Symptoms include redness, itching, eye and eyelid swelling, tearing, and tenderness in front or below the ear(s) from inflamed lymph nodes. I remember when I caught it from a patient and had the itchiest eyes of my life 24 hours a day, definitely not fun. It usually starts in one eye and spreads to the fellow eye a few days later. Other side effects include subepithelial infiltrates (Figure 2), which can reduce vision and cause halos around lights at night, which I had for several years and a pseudomembrane (Figure 3). It can be diagnosed
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
The sign that I find most diagnostic is the presence of pinpoint hemorrhages in the palpebral conjunctive (Figure 6). Traditional treatment includes cold compresses and artificial tears. More aggressive treatment includes steroid and antiviral drops. The redness lasts two to four weeks and is infectious until the eyes are no longer red when not using steroids. Note that this the only disease that I know of that includes the word epidemic.
The reason for writing this newsletter is to tell you about an off-label treatment using Betadine (Figure 7). About ten years ago I had read about it and bought some Betadine when one of my existing patients came in with EKC. He was going to a wedding in a few days. I was reluctant to try it because I did not want to hurt his eye. He said let’s do it. So, I used the Betadine and his eyes were normal for the wedding. Since then, the Betadine treatment has been successful in 7/12 patients. Studies have shown that the Betadine treatment works best if used the first week of infection. Many of the unsuccessful ones had it for over a week. A common scenario is the patient going to their PCP who prescribes an antibiotic, which does not work, then they come to me but by the time I see the patient it is over a week since onset. So, I encourage you to call the office if you get a red eye.
Figure 6
Figure 7