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Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis.
Prog Retin Eye Res. 2020 05; 76:100826.PR

Abstract

Known to occur in widespread outbreaks, epidemic keratoconjunctivitis (EKC) is a severe ocular surface infection with a strong historical association with human adenovirus (HAdV). While the conjunctival manifestations can vary from mild follicular conjunctivitis to hyper-acute, exudative conjunctivitis with formation of conjunctival membranes, EKC is distinct as the only form of adenovirus conjunctivitis in which the cornea is also involved, likely due to the specific corneal epithelial tropism of its causative viral agents. The initial development of a punctate or geographic epithelial keratitis may herald the later formation of stromal keratitis, and manifest as subepithelial infiltrates which often persist or recur for months to years after the acute infection has resolved. The chronic keratitis in EKC is associated with foreign body sensation, photophobia, glare, and reduced vision. However, over a century since the first clinical descriptions of EKC, and over 60 years since the first causative agent, human adenovirus type 8, was identified, our understanding of this disorder remains limited. This is underscored by a current lack of effective diagnostic tools and treatments. In part, stasis in our knowledge base has been encouraged by the continued acceptance, and indeed propagation of, inaccurate paradigms pertaining to disease etiology and pathogenesis, particularly with regard to mechanisms of innate and adaptive immunity within the cornea. Owing to its often persistent and medically refractory visual sequelae, reconsideration of key aspects of EKC disease biology is warranted to identify new treatment targets to curb its worldwide socioeconomic burden.

Authors+Show Affiliations

Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address: james_chodosh@meei.harvard.edu.

Pub Type(s)

Journal Article
Review
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31891773

Citation

Jonas, Rahul A., et al. "Mystery Eye: Human Adenovirus and the Enigma of Epidemic Keratoconjunctivitis." Progress in Retinal and Eye Research, vol. 76, 2020, p. 100826.
Jonas RA, Ung L, Rajaiya J, et al. Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis. Prog Retin Eye Res. 2020;76:100826.
Jonas, R. A., Ung, L., Rajaiya, J., & Chodosh, J. (2020). Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis. Progress in Retinal and Eye Research, 76, 100826. https://doi.org/10.1016/j.preteyeres.2019.100826
Jonas RA, et al. Mystery Eye: Human Adenovirus and the Enigma of Epidemic Keratoconjunctivitis. Prog Retin Eye Res. 2020;76:100826. PubMed PMID: 31891773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis. AU - Jonas,Rahul A, AU - Ung,Lawson, AU - Rajaiya,Jaya, AU - Chodosh,James, Y1 - 2019/12/28/ PY - 2019/10/18/received PY - 2019/12/20/revised PY - 2019/12/26/accepted PY - 2021/05/01/pmc-release PY - 2020/1/1/pubmed PY - 2020/1/1/medline PY - 2020/1/1/entrez KW - Adaptive immunity KW - Epidemic keratoconjunctivitis KW - Human adenovirus KW - Innate immunity KW - Subepithelial infiltrates SP - 100826 EP - 100826 JF - Progress in retinal and eye research JO - Prog Retin Eye Res VL - 76 N2 - Known to occur in widespread outbreaks, epidemic keratoconjunctivitis (EKC) is a severe ocular surface infection with a strong historical association with human adenovirus (HAdV). While the conjunctival manifestations can vary from mild follicular conjunctivitis to hyper-acute, exudative conjunctivitis with formation of conjunctival membranes, EKC is distinct as the only form of adenovirus conjunctivitis in which the cornea is also involved, likely due to the specific corneal epithelial tropism of its causative viral agents. The initial development of a punctate or geographic epithelial keratitis may herald the later formation of stromal keratitis, and manifest as subepithelial infiltrates which often persist or recur for months to years after the acute infection has resolved. The chronic keratitis in EKC is associated with foreign body sensation, photophobia, glare, and reduced vision. However, over a century since the first clinical descriptions of EKC, and over 60 years since the first causative agent, human adenovirus type 8, was identified, our understanding of this disorder remains limited. This is underscored by a current lack of effective diagnostic tools and treatments. In part, stasis in our knowledge base has been encouraged by the continued acceptance, and indeed propagation of, inaccurate paradigms pertaining to disease etiology and pathogenesis, particularly with regard to mechanisms of innate and adaptive immunity within the cornea. Owing to its often persistent and medically refractory visual sequelae, reconsideration of key aspects of EKC disease biology is warranted to identify new treatment targets to curb its worldwide socioeconomic burden. SN - 1873-1635 UR - https://www.unboundmedicine.com/medline/citation/31891773/Mystery_eye:_Human_adenovirus_and_the_enigma_of_epidemic_keratoconjunctivitis L2 - https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(19)30113-2 DB - PRIME DP - Unbound Medicine ER -
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