Keratoconjunctivitis: Symptoms, Types, Causes and Treatment

Keratoconjunctivitis is a group of eye disorders characterized by the inflammation of both the cornea and conjunctiva. While it can affect people of all ages, certain forms are more common in specific populations, ranging from children with allergies to adults experiencing viral outbreaks. Understanding the symptoms, types, causes, and treatments of keratoconjunctivitis is essential for timely diagnosis and effective care—helping to prevent discomfort, complications, and permanent vision loss.

Symptoms of Keratoconjunctivitis

Keratoconjunctivitis manifests with a range of symptoms affecting the eye’s surface. These symptoms can vary in severity depending on the underlying cause, but they generally reflect irritation and inflammation of the ocular tissues. Recognizing these signs early is crucial for prompt management and prevention of complications.

Symptom	Description	Common In	Source(s)
Redness	Eye appears bloodshot or injected	All types	1 3 5 7 8
Itching	Uncomfortable urge to rub the eyes	Allergic types	1 4 7 10
Tearing	Excessive watery discharge	All types	1 3 5 8
Discharge	Mucous, ropy, or watery secretions	Allergic, viral	1 3 4 8
Photophobia	Sensitivity to light	Severe/allergic	1 5 10
Pain	Ranges from mild discomfort to severe pain	Severe/with ulcers	1 5 10
Blurred vision	Decreased clarity of sight	Severe cases	4 5 10
Foreign body sensation	Feeling of something in the eye	All types	5 10
Swelling	Eyelids or conjunctiva may appear puffy	Allergic, viral	7 8
Preauricular lymphadenopathy	Swollen lymph nodes near ear	Viral types	2 3 8

Table 1: Key Symptoms

Common Symptoms Across Forms

Most individuals with keratoconjunctivitis experience redness, tearing, and some form of discomfort. Itching is particularly prominent in allergic types such as vernal and atopic keratoconjunctivitis, while viral forms more often present with watery discharge and lymph node swelling near the ear (preauricular lymphadenopathy) 1 2 3 4 8.

Unique and Severe Presentations

• Photophobia: Sensitivity to light is a hallmark of more severe cases, especially when the cornea is involved, such as in vernal keratoconjunctivitis (VKC) or when corneal ulcers form 1 5 10.
• Pain and Vision Changes: Severe pain and blurred vision typically signal complications like corneal ulcers or scarring, demanding prompt medical attention 1 4 5 10.
• Discharge: The nature of eye discharge can vary—mucous and “ropy” in allergic types, watery in viral forms 1 3 4 8.

Diagnosis and Impact

Symptoms are usually bilateral but can start in one eye, particularly with viral forms. The chronicity, presence of discharge type, and associated findings like swollen lymph nodes help differentiate between the various types and causes of keratoconjunctivitis 3 4 8.

Types of Keratoconjunctivitis

Keratoconjunctivitis is not a single disease but describes several distinct entities. Each type has unique features, risk factors, and clinical presentations.

Type	Population Affected	Key Features	Source(s)
Vernal (VKC)	Children, young males	Seasonal, severe itching, risk of vision loss	1 6 7 9 10
Atopic (AKC)	Adolescents, adults, elderly	Chronic, linked to atopic dermatitis, vision risk	4 18
Epidemic (EKC)	All ages, outbreaks possible	Highly contagious, watery discharge, lymphadenopathy	2 3 8 11
Pharyngoconjunctival fever	Children, communities	Fever, sore throat, conjunctivitis	8 11
Other viral	Various	Mild to moderate symptoms	8 11 5
Non-infectious	Various	Due to dryness, allergies, chemicals	4 18

Table 2: Types of Keratoconjunctivitis

Vernal Keratoconjunctivitis (VKC)

VKC is a chronic, bilateral, seasonally exacerbated allergic inflammation of the ocular surface, mainly affecting children and young males. It is particularly prevalent in warmer climates and can lead to vision loss if not managed aggressively. VKC is marked by severe itching, photophobia, giant papillae on the upper eyelid (cobblestoning), and thick mucous discharge. Corneal involvement can lead to ulcers and scarring 1 6 7 9 10.

Atopic Keratoconjunctivitis (AKC)

AKC generally starts in late adolescence or adulthood and can persist into old age. It is closely associated with atopic dermatitis and presents as a chronic, bilateral inflammation with persistent itching, burning, mucous discharge, and potential for severe complications such as cataracts or glaucoma. Vision loss can occur with chronic disease or steroid overuse 4 18.

Epidemic Keratoconjunctivitis (EKC)

EKC is a highly contagious viral infection, most commonly caused by adenovirus. It affects people of all ages and is often responsible for community or healthcare-associated outbreaks. EKC typically presents with redness, watery discharge, corneal involvement (subepithelial infiltrates), and preauricular lymphadenopathy. The disease is self-limiting but can lead to prolonged symptoms if the cornea is involved 2 3 8 11.

Other Types

• Pharyngoconjunctival fever: Another adenoviral syndrome, more common in children, featuring fever, sore throat, and conjunctivitis 8 11.
• Non-infectious causes: Chemical exposure, severe dryness (as in Sjögren’s syndrome), or other allergic reactions can also result in keratoconjunctivitis 4 18.

Causes of Keratoconjunctivitis

Understanding the root causes of keratoconjunctivitis is critical for effective therapy and prevention. The causes can be broadly grouped into infectious and non-infectious origins.

Cause Type	Example/Trigger	Mechanism	Source(s)
Viral	Adenovirus, COVID-19	Direct infection, inflammation	2 3 5 8 11
Allergic	VKC, AKC (pollen, dust, atopy)	Hypersensitivity, immune-mediated	1 4 6 7 9 10
Environmental	Dryness, chemicals	Irritation, immune response	4 18
Systemic Disease	Atopic dermatitis, Sjögren’s	Immune dysfunction	4 18

Table 3: Causes of Keratoconjunctivitis

Infectious Causes

Adenovirus
Adenovirus is the most common cause of infectious keratoconjunctivitis, particularly in epidemic forms (EKC). It spreads rapidly through direct contact, contaminated surfaces, or medical instruments. Outbreaks are common in schools, hospitals, and communities, especially during warmer months. Other viruses, such as COVID-19, can also cause keratoconjunctivitis, sometimes as the sole manifestation of infection 2 3 5 8 11.

Allergic Causes

Vernal and Atopic Keratoconjunctivitis
These are immune-mediated diseases. VKC is often triggered seasonally by environmental allergens like pollen, while AKC is associated with chronic atopy and may flare with exposure to dust, animal dander, or other allergens. The immune response involves various cells, including eosinophils, T-helper cells, mast cells, and more, producing chronic inflammation 1 4 6 7 9 10.

Environmental and Systemic Factors

• Dryness: Severe dryness or exposure to irritants (like chemicals) can inflame the ocular surface, sometimes leading to non-infectious keratoconjunctivitis 4 18.
• Systemic diseases: Conditions like atopic dermatitis (in AKC) or autoimmune diseases (e.g., Sjögren’s syndrome) can contribute to the development of keratoconjunctivitis 4 18.

Treatment of Keratoconjunctivitis

Management of keratoconjunctivitis is tailored to the underlying cause and the severity of symptoms. The goals are to control inflammation, relieve symptoms, prevent complications, and limit transmission in infectious cases.

Treatment	Indication/Type	Notes/Key Points	Source(s)
Supportive care	All types	Lubricants, cold compresses	3 8 16
Antihistamines/Mast cell stabilizers	Allergic types	First-line for mild/moderate cases	1 4 10 19
Corticosteroids	Severe allergic, EKC (short-term)	Potent anti-inflammatory, risk of side effects	1 4 10 19
Immunomodulators	Severe/Chronic allergic	Cyclosporine A, tacrolimus; for steroid-sparing	1 6 9 10 17 19
Antivirals	Rarely indicated	No proven efficacy in EKC	16
Systemic therapy	Severe AKC, VKC	Oral corticosteroids, antihistamines	4 18
Surgery	Complications	For ulcers, glaucoma, cataracts	1 10
Infection control	EKC, viral types	Isolation, hygiene, avoid spread	8 11 13

Table 4: Main Treatment Approaches

Supportive and Symptomatic Care

• All types: Artificial tears, lubricants, and cold compresses help relieve discomfort. In viral types, this forms the mainstay as the disease is usually self-limited 3 8 16.

Pharmacologic Treatments

Allergic Keratoconjunctivitis (VKC, AKC)

• Antihistamines and Mast Cell Stabilizers: First-line agents for mild to moderate cases. Dual-acting agents can be beneficial 1 4 10 19.
• Corticosteroids: Reserved for severe symptoms or acute flare-ups. They are highly effective but carry risks of increased intraocular pressure, glaucoma, and cataracts with prolonged use 1 4 10 19.
• Immunomodulators: Topical cyclosporine A and tacrolimus are effective in controlling chronic inflammation and serve as steroid-sparing agents. Studies show significant improvement in symptoms and signs of VKC with cyclosporine, with minimal side effects 1 6 9 10 17 19.
• Systemic Therapy: In severe AKC or VKC, systemic antihistamines or corticosteroids may be required, especially when ocular and skin symptoms coexist 4 18.

Epidemic/Viral Keratoconjunctivitis

• Supportive care: As there are no specific antivirals effective against adenoviral EKC, management involves lubricants and cold compresses. Antibiotics are not indicated unless secondary bacterial infection develops 3 8 16.
• Infection control: Isolation, strict hand hygiene, and disinfection of medical instruments are paramount to limit spread 8 11 13.
• Steroids: Sometimes used for severe corneal involvement, but must be used cautiously due to the risk of prolonging viral shedding 1 16.

Surgical and Advanced Therapies

• Surgery: Rarely needed. Indicated for complications such as corneal ulcers unresponsive to medical therapy, or for cataract/glaucoma resulting from prolonged steroid use 1 10.
• Emerging therapies: Research into newer agents, such as anti-chemokine receptor antibodies and leukotriene receptor antagonists, is ongoing for difficult cases 6.

Conclusion

Keratoconjunctivitis is a diverse group of ocular surface diseases, each with its own set of challenges. Prompt recognition and tailored treatment are crucial for symptom relief and prevention of complications.

Key takeaways:

• Symptoms: Redness, itching, tearing, discharge, photophobia, and pain are common; severity and presentation vary by type.
• Types: Includes vernal (VKC), atopic (AKC), epidemic (EKC), and others—each with distinct risk factors and clinical features.
• Causes: Range from viral infections (especially adenovirus) to allergic and environmental triggers.
• Treatment: Depends on the cause; supportive care for viral types, anti-allergic and immunomodulatory drugs for allergic types, with cautious use of corticosteroids in severe cases.
• Prevention and management: Good hygiene and infection control are vital for EKC, while chronic cases require regular ophthalmologic monitoring to prevent vision loss.

Early intervention and a multidisciplinary approach can ensure the best possible outcomes for those affected by keratoconjunctivitis.