Epidemic Keratoconjunctivitis (EKC)

Epidemic Keratoconjunctivitis (EKC) is primarily driven by adenoviral agents and is associated with adenovirus D (AdV) which is a non-enveloped double-stranded DNA virus. Protheragen is dedicated to providing innovative epidemic keratoconjunctivitis (EKC) diagnostic and therapeutic development services, including preclinical research and customized solutions.

Overview of Epidemic Keratoconjunctivitis (EKC)

Epidemic keratoconjunctivitis (EKC) constitutes an ocular infection of high contagiousness that results from specific aetiological human adenoviruses (HAdV) of species D types 8, 37, 53, 54, 56, and 64. It presents itself through an acute form of conjunctivitis having severe corneal involvement and may lead to development of subepithelial infiltrates (SEIs), immune‑mediated corneal lesions that typically develop 10‑14 days after onset once active viral replication has largely subsided.

Fig.1 Route of administration of anti-infective drugs. (Luaces-Rodríguez A., et al., 2018)

Corneal Complication: Subepithelial Infiltrates (SEIs)

Subepithelial infiltrates (SEIs) are characteristic nummular corneal stromal lesions, a well‑recognized complication of epidemic keratoconjunctivitis (EKC), though they may also occur in other inflammatory corneal disorders. Arising from delayed‑type hypersensitivity against residual adenoviral antigens rather than ongoing viral replication, SEIs typically emerge 10‑14 days after EKC onset even as acute conjunctival symptoms resolve. Clinically, SEIs can trigger photophobia, glare, irregular astigmatism and visual disturbance; lesions may persist for months to years and occasionally leave permanent corneal opacities.

Fig.2 Intraocular pressure changes during therapeutic of subepithelial infiltrates (SEIs) in epidemic keratoconjunctivitis. (Karaca E. E., 2025)

Diagnostic Methods for Epidemic Keratoconjunctivitis (EKC)

• Antigen Detection Methods
  Techniques such as immunofluorescence and immunochromatography are employed for swift acute diagnosis of EKC. These techniques are cost effective and results can be achieved within 10 minutes. However, their sensitivity is restricted by the phase of infection and the viral load in the infected eye, typically between 88% and 91%.
• Viral Culture
  Viral culture is still the gold standard in the identification of the causative virus. Various cell lines are cultured, including A549, Hep-2, and HeLa. Though very precise, cultivation of viruses is slow and takes 2 to over 21 days for some samples. Such a long duration makes it impractical for regular usage.
• Molecular Methods
  Traditional PCR techniques alongside real time PCR possess great sensitivity and accuracy and have reliable results within a short time frame. They are able to identify DNA fragments of a viral chromosome at low thresholds making them ideal for early detection and typing of adenovirus strains. However, the heterogenous genetics of the different types of adenoviruses makes the construction of universal primers difficult. For exact typing and recombination analysis, whole genome sequencing (WGS) is employed, however, it is expensive and slow which restricts its application to epidemiological studies.

Therapeutics Development for Epidemic Keratoconjunctivitis (EKC)

Our Services

Protheragen offers comprehensive services for the development of diagnostics and therapeutics for Epidemic Keratoconjunctivitis (EKC). Our services include:

Diagnostics Development

• Karyotype Analysis Service
• Omics Analysis Service
• Biomarker Development Service
• Artificial Intelligence Service

Therapeutic Development

• Small Molecule Drug
• Cell Therapy
• Gene Therapy
• Therapeutic Antibody
• Therapeutic Peptide
• Therapeutic Protein
• Customized Therapy Development

Disease Models

• Cotton Rat Infection Models
• New Zealand White Rabbit Infection Models
• C57BL/6J Mouse Infection Models
• Porcine Corneal Cell Culture Models

Preclinical Research

• Pharmacodynamics Study Services
• Pharmacokinetics Study Services
• Drug Safety Evaluation Services
• Customized Research Services

Protheragen offers customized services tailored to meet the specific needs of our clients. Our team works closely with researchers and developers to design and implement studies that address unique research questions and objectives. If you are interested in our services, please feel free to contact us.

References

• Luaces-Rodríguez, Andrea, et al. "Review of intraocular pharmacokinetics of anti-infectives commonly used in the treatment of infectious Epidemic Keratoconjunctivitis (EKC)." Pharmaceutics 10.2 (2018): 66.
• Vaziri, Kamyar, et al. "Epidemic Keratoconjunctivitis (EKC): state of the art." Clinical ophthalmology (2015): 95-108.
• Relhan, Nidhi, Richard K. Forster, and Harry W. Flynn Jr. "Epidemic Keratoconjunctivitis (EKC): then and now." American journal of ophthalmology 187 (2018): xx-xxvii.
• Karaca, Emine Esra, et al. "Evaluating the Efficacy of Topical Tacrolimus Alone and in Combination with Prednisolone for Treating Subepithelial Infiltrates (SEIs) in Epidemic Keratoconjunctivitis." Biomedicines 13.4 (2025): 895.