Correspondence (reply): In Reply

First of all, we wish to thank our correspondents for their letters and our many colleagues who have contacted us directly with their questions and suggestions. All this underlines the importance and topicality of the subject.

Professor Schmidt has highlighted several issues. The information about the slightly changed disease course in children, in whom general symptoms predominate, is important for general practitioners who are expected to make the diagnosis. We also thank him for summarizing the most important symptoms, such as swelling of the plica, caruncle, and preauricular lymph nodes. We mention these in the paragraph entitled “Clinical features.” It is correct that EKC typically does not lead to recurrences. In theory, however, renewed infection with another of the three serotypes mentioned in our article is entirely possible.

In view of today’s clinical or practice routines, we do not think that a Giemsa stained conjunctival scrape, such as probably would have been very useful in 1986, should be recommended, since polymerase chain reaction (PCR) provides a safe and reliable result within less than four hours (1).

We are also grateful for the summary of the most important hygienic measures and symptomatic therapeutic measures. These can be found in our article under the headings “Treatment” and “Hygienic measures in clinical practice.”

We share Dr Werner’s views regarding the estimated numbers of undetected cases of EKC. The Robert Koch-Institute itself reported 489 notified cases for 2010. We are not aware of any explicit recommendation from the RKI with respect to disinfecting contact lenses. The RKI’s advice for physicians says that the fact that pathogens of EKC can be transmitted by means of contaminated ophthalmological instruments underlines the importance of careful preparation or use of non-contact instruments (for example, tonometers), which should be the preferred option wherever possible. This is also true for tolerability of the materials in the relevant agents and procedures (2). We have not seen to the exact requirement from the Baden Württemberg authorities and can therefore not comment.

With regard to Professor Dettenkofer’s correspondence, we wish to point out that selecting the appropriate hand disinfectant is worth discussing. The poorer skin tolerability of hand disinfectants classed as fully virucidal is important and should not be ignored. However, we agree with Dettenkofer that other hand disinfectants that have proven effectiveness against adenoviruses are also suitable.