Follicular Kerato-Conjuntivitis in this boy of 3 years 2

Optom
Continuing on this discuss, in a previous blog I discussed the challenges I faced in managing this 3 year old boy with an Adenoviral type of Kerato-Conjunctivitis with heaps of periauricular lymph nodes superimposing the peripheral cornea of the left eye.
On the last two visits the young boy's eyes had shown a good prognosis. I am currently using a tappered dosing of the topical NSAID, an additional gutt: Ciprofloxacin i every 1hr.
Why did I not use steroids that immuno-suppresses such activitis? Why did I opt for an NSAID that would typically counteract the effect of prostalglandins on the compromised LE but wont influence immune responses? (Note the immune responses against allergens in the eyes manifests in the symptoms common with allergic conjunctivitis?). I might have been awed @ the corneal infiltrates & the exagerated  dilatation of conjunctival vessels. I might have been too cautious in using a topical steroid because this hyper-active boy might be mechanically causing corneal abrassion whenever his eyes irritate him. (His parent said he does not itch his eyes, but who can tell?). I might have weighed the toxic/therapeutic consequences hence my choice of the NSAID over the corticosteroids.
I must have been too careful with the hazy cornea & the age of the boy, hence the use of Gutt: Ciprofloxacin to prophylactically check for opportunistic infection on the cornea. I did a flouresin examination of the cornea in each visit to ensure that the young boy's cornea remains intact.
It should come to our knowledge that allergic conjunctivitis of any type might not respond to a specific regimen of drug(s) but knowing its triggering factor is definately an important step in the right direction.
I have also noticed that prescribing glasses, when indicated, using cooling compresses & applying lubricants either in form of eyedrops or in form of ointments (like I used Chloramphenicol eye ointment both for its broad spectrum antibacterial property & for the viscous nature of the ointment), using antihistamines like Keturtifen Fumerates etc to reduce symptomatic itching, an immune response by the host eye to percieved allergens, have been shown to have tremendous influence in managing adenoviral Kerato-conjunctivitis...remember that type of conjunctivitis that could develop real membrane over the conjunctiva & even threatening to invade cornea itself? Recently, some researchers in clinical practice even suggested using 5% Betadine topical solution to flush off the adenoviral load on the surface of the eye! Betadine is a brand name for Povidone iodine known for its very strong antiseptic & antimicrobial charactaristics. It is often used in cataract surgery to sterilize the adnexa of the eyes in fight against opportunistic bacterias that causes Endophthalmitis.
I saw the young boy yesterday & his parents were very happy. His eyes was clearer. His vision has improved & the lustre of the eye was better. But I adviced her on keeping a close look out for any symptom on the boy's right eye & to gradually lower the dosage of all administered eyedrops... It was so good to be of help! Thanks
Dr Ezebuiroh Victor Okwudiri.

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