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Bob Costas’ Eye Infection

Posted by Dr. J. R. Lacey, Therapeutic Optometrist

Feb 17, 2014 10:54:00 PM

Epidemic Keratoconjunctivitis (EKC) is a Serious Eye Infection that Should be Treated by an Experienced Eye Doctor

Anyone that watched the NBC Sochi Olympics coverage during the first few days could only have empathy for Bob Costas as he battled a severe eye infection. His swollen, red, watery eye continued to get worse and also spread to his other eye. It finally forced him to be completely replaced and taken off the air forcing NBC to scramble for a replacement. It is my opinion that Bob Costas had epidemic keratoconjunctivitis (EKC). Since I did not have the privilege of examining him personally, I can only make that diagnosis from watching him on television and hearing his complaints about his eyes on air. If my diagnosis is incorrect, please accept my apology. However, it is worth learning about the condition so you can avoid the complications.

Introduction

Epidemic Keratoconjunctivitis (EKC) is an infection/inflammation of the cornea and conjunctiva caused by adenovirus (usually serotypes 8 or 19). Epidemic is its first name because it is highly contagious and often spreads to family, friends and business associates as well as to a person’s other eye. Many ask “Is this pink eye?” Since pink eye is not a medical term, but rather a layman’s term that describes most types of conjunctivitis, one might include this as a type of pink eye. However, EKC would be more severe and much longer lasting than the typical “pink eye”.

Cause of Epidemic Keratoconjunctivitis (EKC)

Viral conjunctival infections are possibly caused by airborne respiratory droplets, but most certainly from direct contact such as rubbing one’s infected eye and then touching someone or an object (such as a towel, pen, business equipment, shopping cart, door handle, etc). Another person then comes in contact with the transferred virus and touches their eye or eyelids and transfers the viral infection to their own eye.

Signs and Symptoms of Epidemic Keratoconjunctivitis (EKC)

epidemic keratoconjunctivitisAlthough EKC usually heals without permanent loss of vision it is one of the worst anterior eye infections and causes considerable problems during its period of infection that lasts for weeks or months without proper treatment. There is typically an incubation period of 5-10 days – the time from initial contact with the virus until it causes active disease. It usually starts in one eye and rapidly spreads to the other eye so it is almost always bilateral (both eyes).

During the first five days of active disease there is pain/discomfort, redness of the white part of the eye and excessive tearing (watery/serous discharge from the eyes). There is also eyelid edema (swelling), light sensitivity (photophobia), swelling of the conjunctiva (chemosis) and possibly small punctate sub-conjunctival hemorrhages.

After the first five days the patient is usually feeling quite miserable. Visible to an eye doctor using a high magnification microscope are follicles (small nodular swelling of lymphocytes) and a keratitis (inflammation of the cornea) that is now taking place in the eye. The keratitis (corneal infection) is present in both the epithelium and stromal layers of the cornea. The eye doctor can see round sub-epithelial infiltrates (accumulation of white cells within the cornea caused by an immune response) that are present in the cornea, primarily in the central cornea. This corneal involvement is one of the differentiating signs of EKC from other types of viral conjunctivitis. There is often tenderness and swelling of the adjacent lymph nodes and maybe formation of a pseudomembrane in the eyelid conjunctiva. The pseudomembrane is composed of fibrin and white blood cells.

Blurred vision is often present in epidemic keratoconjunctivitis (EKC) due to multiple corneal infiltrates in the central cornea that obscure vision. Infiltrates are lymphocytes (type of white blood cell) that are created by the immune system in response to the adenovirus. These infiltrates can last 3-6 months or even longer and do not cause scarring but can create blurred vision while present in the cornea.

Complications from Epidemic Keratoconjunctivitis (EKC)

Most people are unable to function normally during an EKC infection. There is considerable discomfort, light sensitivity and watery eyes. Additionally, people can be very embarrassed by their appearance during EKC. Because of these issues most people are unable to concentrate on business or work issues and do well to simply perform normal activities of daily living. Because EKC is so highly contagious, people with EKC should be somewhat isolated and avoid too much contact with others.

Conjunctival desiccation (dryness/dehydration) can causes scarring in severe cases of EKC. This can result in adherence of the eyelid to the eye itself. In rare cases the bulbar conjunctiva (clear tissue covering the white part of the eyeball) and palpebral conjunctiva (clear tissue on the underside of the eyelids) will adhere to each other creating a complication known as symblepharon.

Treatment of Epidemic Keratoconjunctivitis (EKC)

Typical Treatment

Patient education about the highly contagious nature of EKC consists of:

  • Stay away from people as much as possible during period of watery discharge
  • Do not share eyeglasses, towels, utensils, pens, pencils, personal items
  • Do not shake hands or come in contact with others
  • Wash hands very, very often and especially before touching public items such as shopping carts and door handles
  • Do not reuse towels or linens that have been in contact with the face

Typical Medical treatment for EKC

Medical treatment for EKC ranges from cold compresses and artificial tears to corticosteroid eye drops two to four times daily. However, corticosteroids are used with caution especially if there is concern that the infection is caused by Herpes.

If a conjunctival membrane is present it should be removed with forceps or a cotton tip swab. After membrane removal an antibiotic should be added to the treatment.

If blurred vision persists after a few weeks, long term corticosteroid therapy with Lotemax may be required to clear the cornea and restore clear vision.

Leading Edge Medical Treatment for Epidemic Keratoconjunctivitis (EKC)

The experts at Master Eye Associates use a leading edge treatment for EKC, not used by most eye doctors because they are not aware of the new treatment. The treatment consists of using Betadine 5% instilled in the eye during the active phase of infection (usually within the first 5-7 days). After instilling anesthetic drops in the eye, non-steroidal anti-inflammatory (NSAID) drops are instilled. Then several betadine 5% drops are instilled and the patient’s eye should be closed for one minute. Any excess betadine should be spread around the eyelid margins. After one minute the eye should be irrigated with sterile saline and then more NSAID drops instilled. After that is complete, corticosteroid drops should be prescribed for the patient for 4-5 days. The earlier this leading edge treatment is initiated the better. Assuming the patient has no allergy to iodine, this treatment is effective virtually 100% of the time and results in good patient comfort and appearance within two to three days (instead of 3-4 weeks with conventional treatment) and prevents the corneal infiltrates that can blur vision for months.

Having been privileged to provide eye care in the Olympic Village in the 1996 Atlanta Olympics I know the incredible importance of good vision for good performance. I hope that no athletes crossed path with those who had EKC. Unfortunately for Bob Costas and NBC, he did not seek treatment by Master Eye Associates. He could have avoided virtually all the complications had he been properly diagnosed and treated by our state-of-the-art treatment for epidemic keratoconjunctivitis! Hopefully, eye doctors in Russia will see this blog!

Topics: Epidemic Keratoconjunctivitis, Bob Costas' Eye Infection, Severe Pink Eye

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