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The primary transmission method for epidemic adenovirus keratoconjunctivitis is through direct contact. This viral infection spreads easily from person to person, typically via contaminated hands or surfaces, such as towels, eye makeup, or surgical instruments. When an infected individual touches their eyes or face and then comes into contact with someone else, or when surfaces in close proximity are touched, the virus can easily transfer and cause infection.

Airborne droplets are not the primary mode of transmission for this type of viral conjunctivitis. While respiratory infections can be transmitted this way, adenovirus keratoconjunctivitis primarily occurs through direct touching of infected areas.

Applanation tonometry refers to a specific eye examination technique used for measuring intraocular pressure, and while it can pose a risk for the spread of infections if equipment is not properly sterilized, it is not a primary means of adenovirus keratoconjunctivitis transmission.

Water contamination is associated with other types of conjunctival infections, such as those caused by certain bacteria in poorly maintained water sources, but not predominantly with adenovirus keratoconjunctivitis. Thus, understanding the direct contact route is crucial for preventing the spread of this viral infection.