Abstract

Viral keratoconjunctivitis is one of the most common contagious ocular conditions encountered in ophthalmic practice. Multifocal subepithelial infiltrates (SEIs) represent its most frequently observed and clinically significant complication, with an estimated incidence ranging from 49.1% to 80%. SEIs are believed to result from cellular immunological reactions triggered by adenoviral replication in the corneal stroma beneath Bowman’s membrane. This narrative review examined the evidence for medical and surgical management strategies for SEIs associated with viral keratoconjunctivitis, using PubMed, Google Scholar, and Web of Science databases guided by PRISMA methodology, including 66 relevant articles published after 1990. Corticosteroids provide short-term symptom relief but carry risks of recurrence upon discontinuation and serious adverse effects including cataracts, glaucoma, and enhanced viral replication. Corticosteroid-sparing agents -- cyclosporine A and tacrolimus -- demonstrate superior efficacy with lower recurrence rates and a more favourable safety profile, though tacrolimus may cause burning and foreign-body sensation. Surgical approaches, particularly phototherapeutic keratectomy (PTK) and photorefractive keratectomy (PRK), yield significant long-term improvements in visual acuity and corneal transparency. The adjunctive use of mitomycin C (MMC) with PTK or PRK substantially reduces postoperative haze and recurrence risk. In conclusion, corticosteroid-sparing agents and excimer laser procedures with MMC offer superior long-term outcomes. Controlled comparative studies with extended follow-up periods are required to validate these results and further define recurrence rates.

Key words: Viral keratoconjunctivitis, Subepithelial infiltrates, Adenovirus, Corticosteroid-sparing agents, Phototherapeutic keratectomy, Photorefractive keratectomy