Adenovirus Ocular Infections: Prevalence, Pathology, Pitfalls, and Practical Pointers.

Adenoviral conjunctivitis comprises a large number of physician office visits in the United States and places a great financial burden on health care. It is estimated that the incidence of adenovirus infection to be as high as 20 million cases per year in the United States. There are multiple adenovirus serotypes, each associated with different types and severity of infection. Ocular manifestations of adenovirus include epidemic keratoconjunctivitis, pharyngoconjunctival fever, and nonspecific conjunctivitis. Adenoviral conjunctivitis is primarily a clinical diagnosis. Laboratory diagnosis is available although until recently rarely used. At present, there is no established or approved specific effective drug against adenovirus. Treatment is primarily supportive and includes artificial tears and cool compresses. Topical antibiotics are only indicated if a bacterial coinfection is suspected or in high-risk patients such as children. Prevention against this extremely contagious disease is of utmost importance. Although most cases are self-limited and have a relatively benign course, permanent visual disability can occur. For this reason, it is imperative that all eye care providers are capable of diagnosing and effectively treating these patients, and also preventing the spread of this contagious disease to others.

Ocular surface diseases and corneal refractive surgery.

PURPOSE OF REVIEW: The purpose of this article is to provide an overview and update on recent literature regarding ocular surface disease and corneal refractive surgery. RECENT FINDINGS: Studies involving ocular surface disease and/or keratorefractive (corneal) surgery published found on the Medline database were included in the report. Studies focused on mechanisms of refractive surgery induced dry eye disease, surgical options, including modification of technique, to prevent dry eye, and postoperative dry eye prevention and management by way of both established and novel therapies. SUMMARY: By understanding the mechanisms of postoperative dry eye as well as patient risk factors for dry eye, patient satisfaction and surgical outcomes can be maximized. Patients identified as having an increased risk for postoperative dry eye may benefit from surgical techniques such as small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (LASIK). Employing well known therapies such as preserved and nonpreserved artificial tears, nutritional supplements, topical cyclosporins, punctal plugs and autologus serum as well as novel therapies such as insulin-like growth factor 1, neuropeptides and acupuncture could provide improve outcomes and, if started early, could allow more patients to be candidates for corneal refractive surgery.