Current treatment of presumed viral keratoconjunctivitis
Patients with viral keratoconjunctivitis are both highly infectious and at significant risk of visual loss, particularly with certain strains of adenoviral infection.
Povidone-Iodine therapy is known to be an effective treatment for adenoviral keratoconjunctivitis. Unfortunately there is no commercially available product. Practitioners therefore need to compound it on a patient by patient basis.
Currently, having trialled a variety of protocols, my current practice for patients with presumed or proven viral conjunctivitis is as follows:
A 50/50 mix of Povidone-Iodine and Prednisolone phosphate is mixed by expressing half of the contents of a Predsol minim and then aspirating Povidone-Iodine back up into the minim. Following topical anaesthesia, this solution is used to copiously irrigate the ocular surface, paying particular attention to the upper and lower fornices and lid margins. Treatment is repeated on three consecutive days due to eradicate intracellular virus. From the first day of treatment, Predsol drops are supplied to the patient, to be used qid for approximately ten days.