Anti-Viral Agents FINAL EXAM MATERIAL - Clinical Ocular Pharmacology Spring 2026

What is Epidemic Keratoconjunctivitis caused by?

specific adenovirus serotypes 8,18,37

Do humans have natural immunity to EKC serotypes 8, 18, 37?

No

Is EKC very contagious?

Yes -- the virus can survive on surfaces for 8-12h

What is the range of symptoms with EKC?

wide range of symptoms

Viral Conjunctivitis (Pic)

Viral Conjunctivitis (Pic)

What are the common symptoms of viral conjunctivitis?

-watery discharge

-small lacy vessels (pink eye)

-not painful

What is the normal treatment for viral conjuntivitis?

palliative care

EKC (Pic)

EKC (Pic)

What are the common symptoms of EKC?

-lid edema

-conj chemosis

-VERY PROFUSE tearing

-patients are very uncomfortable

What is the cause of petechial hemes on the conj in patients with EKC?

so much vasodilation in the area of the conj

What is a common finding of EKC that is confused with mucopurulent discharge?

pseudomembrane

Why is a pseudomembrane, "pseudo"?

it is not physically attached to the underlying conjunctival membrane

Pseudomembrane (Pic)

Pseudomembrane (Pic)

EKC with Lid Edema (Pic)

EKC with Lid Edema (Pic)

What is the rule of 7s that is associated with EKC?

-7 days of prodromal phase

-7 days of conjunctivitis symptoms

-7 days after is when the onset of keratitis will begin

Do all patients with EKC progress to keratitis?

No

Are subepithelial infiltrates (SEIs) common in EKC?

Yes -- during the keratitis phase

What are the characteristics of the SEIs in EKC?

multiple, hazy, diffuse, infiltrates that are throughout the central cornea

The SEIs of EKC keratitis will likely stain (+/-)

-

Is there active infection still present in the keratitis phase of EKC? What are the infiltrates d/t?

No -- the infiltrates are STERILE & d/t an inflammatory rxn to the viral proteins

Should SEIs from EKC keratitis be treated with a steroid?

No -- This condition is prone to rebound inflammation

What kind of treatment is used for the SEIs of EKC keratitis?

palliative care

What is the in office method to detect adenovirus?

RPS Adenovirus Detector

How to perform the RPS Adenovirus Detector Test?

-swab the conj 6-8 times

-test results available in 10 min

What does the RPS Adenovirus Detector Test detect?

ALL serotypes of viral conjunctivitis (adenovirus)

Is the RPS Adenovirus Detector Test specific for EKC?

No

What is the sensitivity & specificity of RPS Adenovirus Detector Test?

-sensitivity 89%

-specificity 94%

What is used for the betadine procedure for EKC?

Ophthalmic Betadine -- 5% Providone-Iodine

How to perform the Betadine Procedure for EKC?

-1 gtt 0.5% Proparacaine

-2 gtts topical NSAID

-4-6 drops ophthalmic betadine solution

-close eyes and roll them around for 60-90 sec

-rinse with sterile saline

-2 gtts topical NSAID

-loteprednol QID x 4 days

What is Betadine?

universal antiseptic solution

What is Betadine used for in the Betadine Procedure for EKC?

to lyse microorgansims of all types

Will you cause inflammation during the Betadine Procedure for EKC?

yes -- this is why you rx a steroid. Will make the presentation of the viral conjunctivitis WORSE before it gets BETTER

Are patients contagious after the use of the Betadine?

No -- all the viral microorganisms are lysed

When doing the Betadine Procedure for EKC, you should treat (one eye/both eyes)?

both eyes

Are patients with stromal keratitis d/t EKC a candidate for the Betadine Procedure?

No -- it is too late at this point

What is an off-label treatment for EKC?

Zirgan

True or False:

In a study on Zirgan with EKC, those treated with Zirgan resolved faster than those in the control group

True -- 7.7 days compared to 18.5 days for control

Did less patients develop SEIs when treated with Zirgan as compared to the control group?

Yes -- 22% of patients developed SEIs with Zirgan; 77% developed SEIs in the control group

What population of patients is most likely to develop cytomegalovirus (CMV)?

HIV patients

What are the 3 medications that are used in the treatment of cytomegalovirus (CMV)?

-ganciclovir

-foscarnet

-cidofovir

What is the route of administration of ganciclovir?

IV med implant

What is the route of administration of foscarnet?

IV only

What is the route of administration of cidofovir?

IV only