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   Table of Contents      
ARTICLES
Year : 1977  |  Volume : 25  |  Issue : 4  |  Page : 33-36

A study of 105 cases of keratoconjunctivitis


1 Institute of Post-graduate Medical Education and Research, Calcutta, India
2 Calcutta Medical College, India
3 Bankura Sanmilani Medical College, Bankura (West Bengal), India

Correspondence Address:
S C Sen
Department of Ophthalmology, Institute of Post-Graduate Medical Education and Research, Calcutta
India
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Source of Support: None, Conflict of Interest: None


PMID: 659006

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How to cite this article:
Sen S C, Saha P L, Banerjee A R, Das A K. A study of 105 cases of keratoconjunctivitis. Indian J Ophthalmol 1977;25:33-6

How to cite this URL:
Sen S C, Saha P L, Banerjee A R, Das A K. A study of 105 cases of keratoconjunctivitis. Indian J Ophthalmol [serial online] 1977 [cited 2020 Aug 14];25:33-6. Available from: http://www.ijo.in/text.asp?1977/25/4/33/34611

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At Bankura (West Bengal), we come across fairly a large number of cases of keratocon­junctivitis. Our observations of a clinical' study are presented in this article.


  Materials and Methods Top


During the period from July, 1973 to December, 1974, 105 cases of keratoconjunctivitis were examined at ophthalmic outpatients' Department of Bankura Sanmilani Medical College Hospital. Corneal involve­ment due to leprosy, which is endemic in Bankura has not been included in this study, Trachoma, a rare disease in rural areas of West Bengal has also been excluded. Cases of conjunctivitis, without mucopurulent discharge, but having corneal involvement, initially or during its course are only included in this study. The occupation, the bathing habits, history of trauma, affection of other members of the family were enquired. All casese were examined thoroughly. Slit lamp examination was also done after staining with fluorescein. Corneal sensation was tested with wisp of sterile cotton. Vision was tested. Involvement of preauricular lymph node and systemic affections were also noted.


  Observation Top


Out of 105 cases, 69 (65.7%) were males and 36 (34.3%) were females. Maximum age incidence was between 21-30 years [Table - 1]. 72 (68.6%) cases came from rural area and most of them were cultivators. Except in one case other members of the family were not affected.

91 (86.7%) cases gave history of bath in ponds or sprinkling of muddy water in eyes during cultivation, before their ocular com­plaints started. None gave any history of trauma, 18 cases (17.1%) gave history of attacks of colds during onset of the disease. The incid­ence of the disease was highest in rainy season (44.8% in August). It gradually declined during autumn and winter. It was absent during spring and summer [Table - 2].

In 91 cases (86.7%), the disease was unila­teral. Maximum patients (43.6%) attended initially on the 4th day of their illness. The three patients who attended hospital for the first time in the 3rd week of their illness had got some treatment outside and one of them had secon­dary bacterial infection later on. Only one case gave history of a similar attack in the same eye about three years back.

Clinical features: Circumcorneal congestion, photophobia, foreign-body sensation, watering and blurring of vision in the affected eye were present in all cases. Typical appearance was unilateral redness of the eye with relatively smaller palpebral fissure, due to blepharospasm and slight swelling of the lid margins on the affected side. Follicles were present usually in the lower fornix in 36 (34.3%) cases. Muco­purulent discharge was absent except in one who had secondary bacterial infection and developed hypopyon corneal ulcer. In 17 cases, who attended initially on 2nd or 3rd day of their illness, no punctate opacities in cornea could be detected but superficial punctate keratitis (SPK) was detected on next visit. From 4th day onward, cornea was involved in all cases. On slit lamp examination, corneal lesion appeared as fine, round, non-elevated epithelial or sub-epithelial infiltrations. Epithelial eros­ions, were detected with fluorescein staining in a few cases. The common site of these super­ficial punctate infiltrates were central and lower para-central regions of cornea, peripheral parts were relatively free. Corneal lesion was milder in younger patients. In three cases corneal infil­trates were extensive and sizes of corneal spots varied from 1 mm and 3 mm, which subsequently coalasced, resulting diffuse super­ficial Keratitis. Corneal sensation was diminished or totally lost in 99 (94.3%) cases. Only in six cases, corneal sensation appeared normal.

Preauricular nodes were enlarged and tender on the affected side in 63 (60%) cases. Visual impairment was mild in 50 cases, mode­rate in 51 cases and severe in three cases at initial visit [Table - 3].

Treatment and course: The cases were treated with chloramphanicol eye drops and atropine locally. Vitamin B complex was used orally where deficiency was suspected.

Only 65 (61.9%) patients attended regularly till they were cured of their symptoms. 55 out of 65 cases got back their normal vision with a period from two to three weeks. 7 cases had a few spots of corneal opacities, without corneal vascularisation and facet formation. Three cases developed diffuse Keratitis and one case deve­loped hypopyon corneal ulcer with much impairment of vision and in these cases the course was prolonged to about three months.


  Discussion Top


Epidemic or adenovirus Keratoconjunctivitis is a widespread disease, reported from almost all parts of the world [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18][20],[25] . The kerato­conjunctivitis cases seen at Bankura, which were also reported previously [1],[2] clinically appear­ed to be a milder type of adenovirus keratocon­junctivitis. Unlike keratoconjunctivitis occuring in epidemics reported by various workers [3],[4],[5],[11],[16],[20],[24] these casse are milder in nature. Virulence of the disease depends on the type of adenovirus [4],[9] and also on the climate [19] . As regards effects of climate on adenovirus Keratoconjunctivitis the comment of Sen [19] in being quoted here. "The effect of the climate on the disease may be found in cases of SPK. It is fairly virulent in the West, less so in Bombay and Madras. In Bengal, it is very mild, so much so that nearly 100% of the cases can be cured with simple treatment without leaving any trace of corneal opacities".

These cases also occured in non-epidemic form and can be regarded as non-infectious. There was no evidence of person to person transmission. In this respect it resembles keratitis superficialis tropica reported from Ceylon [6] .

Majority of the cases (86.7%) gave history of bath in dirty water of ponds before their ocular infection. In these cases polluted water may be the source of infection. Keratocon­junctivitis after bath in polluted water have previously been reported. [1],[2],[15],[17] Further investigation including viral culture and serolo­gical studies are required to find out whether it is an ocular infection due to a milder type of adenovirus or a sort of inclusion conjunctivitis due to TRIC virus. TRIC virus may also cause punctate Keratoconjunctivitis and the condition may be mistaken for epidemic keratocon­ junctivitis [9],[12] .

Clinically it is difficult to differentiate between various types of viral keratocon­junjctivitis, particularly at the initial visit. Three of our cases which ultimately developed diffuse superficial keratitis, were probably herpes simplex keratoconjunctivitis and were mistaken for adenovirus keratoconjunctivitis at the initial visit.

We observed an high incidence of keratocon­junctivitis in the rainy season, probably because the pond water of this area becomes muddy and more polluted in this season and most of our patients gave history of bath in pond water. Low incidence (2.9%) of keratoccnjunctivitis in children has been observed. Lack of corneal involvement in children in adenovirus infection has also been reported by Mitsui et al[14] and Dawson et al[7].


  Summary Top


Observation of a clinical study of 105 cases of Keratoconjunctivitis during a period of one and half years have been reported. The disease is mostly unilateral with preauricular lymphad­enopathy and diminished corneal sensation, commonly found in young adults, after a bath in dirty water of a pond. It is cured with simple treatment with local antibiotics. The average course is about three weeks. Compli­cations are few. The possible etiology has been discussed.

 
  References Top

1.
Ahmed, E. and Bose. J., 1964, Bull. Madras State Ophthal., 1, 109.  Back to cited text no. 1
    
2.
Ahmed, E. and Roy. S.N., 1973, Ophthal., 21, 23.  Back to cited text no. 2
    
3.
Braley, A.E., 1957, Amer. J. Ophthal., 43, 4, Part II, 44.  Back to cited text no. 3
    
4.
Beitti, G.B. and Bruna, F., 1957, Amer. J. Ophthal., 43, 4, Part II, 50.  Back to cited text no. 4
    
5.
Chohan, B.S., Sharma, J.L. and Prem Chandra, 1973, Ind. J. Ophthal., 21, 121.  Back to cited text no. 5
    
6.
Committee on Keratitis Superficialis Tropica, 1957, Amer. J. Ophthal., 43, 4, Part II, 64.  Back to cited text no. 6
    
7.
Dawson, C.R., Darrell, R., Hanna. L. and Jaisetz, 1963, New Eng. J. Med., 268, 19, 1934.  Back to cited text no. 7
    
8.
Dawson, C.R., Hanna, L. Wood, T.R. and Despair R. 1970, Amer. J. Ophthal., 69,473.  Back to cited text no. 8
    
9.
Duke Elder, S. 1965, System of Ophthalmology, 8, Part II, 733, Henry Kimpton, London.  Back to cited text no. 9
    
10.
Fuchs, E., 1889, quoted by Duke Elder, 1965, System of Ophthalmology, 8 Part II, 733, Henry Kimpton, London  Back to cited text no. 10
    
11.
Hogen, M.J., 1957, Amer. J. Ophthal., 43, 4, Part II, 41.  Back to cited text no. 11
    
12.
Jones, B., 1961, Trans. Ophthal., Soc., U.K., 81. 367.  Back to cited text no. 12
    
13.
Kirwan, E. 1933, Proc. All. Ophthal., Soc., 3, 1.   Back to cited text no. 13
    
14.
Mitsui, Y., Hanna, L., Hanabusa, J., Minoda, R., Ogata, S., Kurihara, H., Okanama, R. and Mirura, M. 1959, Arch. of Ophthal., 61, 891.  Back to cited text no. 14
    
15.
15. Mitsui, Y., quoted by Tanaka, C. 1957, Amer. J. Ophthal., 43, 20, 48.  Back to cited text no. 15
    
16.
Ormsby, H.L. and Fowle. A.M.C (1954) Amer. J. Ophthal., 38, 490.  Back to cited text no. 16
    
17.
Otsuka, J., quoted by Tanaka, C., 1957, Amer. J. Ophthal., 43, 20, 48.  Back to cited text no. 17
    
18.
Sanyal S., 1933 Amer. J. Ophthal., 16, 390.  Back to cited text no. 18
    
19.
Sen K, 1962, "XIX Concillium Ophthalmology, New Delhi, Acta" 1, 53.  Back to cited text no. 19
    
20.
Tanaka, C., 1957, Amer. J. Ophthal., 43, 4, P II, 46.  Back to cited text no. 20
    
21.
Thygeson P, 1966, Amer. J. Ophthal., 61, 1344.   Back to cited text no. 21
    
22.
Viswalingham M, 1941 Brit. J. Ophthal., 25, 313.   Back to cited text no. 22
    
23.
Weerkoon L.M, 1956 Brit. J. Ophthal., 40, 691.   Back to cited text no. 23
    
24.
Wright R.E, 1930, Brit. J. Ophthal., 14, 257.  Back to cited text no. 24
    
25.
Yin, Coggrave M. and Loh R.C. 1966, Amer J. Ophthal., 91, 515.  Back to cited text no. 25
    



 
 
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