Miscellaneous keratitis 09.03.16,dr.k.jha

Interstitial keratitis ( IK)Dr K N Jha,MS

Professor of OphthalmologyEmail: kirtinath.jha@gmail.com

Interstitial keratitis

It is an inflammation affecting chiefly the stroma of the cornea.

Cause : infectious or autoimmune.

Infections: syphilis, M. leprae and tuberculosis, EB virus, Lyme disease, sarcoidosis, Cogan syndrome, mumps and rubeola keratitis, Chlamydia, LGV, Acanthamoeba, Leishmania.

Interstitial Keratitis due to syphilis

Majority are due to congenital syphilis, with bilateral involvement in 80% cases.

Acquired adult syphilis produces IK much less frequently, and it is unilateral.

Clinical featuresPain, CCC, lacrimation, photophobia, and

blepharospasm

Diffuse corneal haze ( Nonulcerative stromal keratitis )and neovascularization, uveitis.

Acute inflammatory edema resolves with the progressive vascular invasion

Deep opacities and ghost vessels

Hearing impairment and chorioretinal scarring

ManagementDiagnosis is confirmed with blood tests: FTA-ABS or

MHA-Treponema pallidum (MHA-TP)

Follow-up with VDRL

Test also for HIV

Treat syphilis on usual lines.

Topical steroid therapy: Prednisolone 1% qid to 8id for 1 m to 2 m then tapered.

Cycloplegics

Exposure and Neurotrophic Keratitis

Exposure KeratopathyExposure keratopathy can result from any

disease that limit eyelid closure

VII nerve palsy, cicatricial ectropion, Parkinson disease, proptosis, comatose patients

Lagophthalmos

Clinical features

Punctate epithelial keratopathy involving lower third of the cornea

May involve whole of the cornea in ulceration, melting and perforation

Symptoms of corneal ulcer unless cornea is anaesthetic

Management of Exposure KeratopathyMedical therapy: non-preserved tear

substitute, eye ointment and taping of eyelids at night.

Surgical therapy:

- Lateral tarsorrhaphy

- Insertion gold or platinum weight in the upper eyelid

Neurotrophic KeratopathyNeurotrophic keratopathy results from

damage to cranial nerve V

Etiology: Surgery, CVA, Viral infections of cornea,topical medications, Hansen disease

Clinical featuresUsually involves central or inferior

paracentral cornea

Sterile persistent epithelial defect with rolled up, elevated edges

May lead to ulceration, perforation and loss of eye

Neurotrophic ulceration

Management Treat the cause and treat lagophthalmos

Topical tear substitute, and eye ointment

Tetracycline and Medroxyprogesterone ointment

Autologous serum drop

Bandage contact lenses

Amniotic membrane grafting.

Points to rememberInterstitial Keratitis

Neurotrophic keratitis

Lagophthalmos: Cause, complication and Treatment