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Keratitis

Corneal Inflammation

Keratitis is a condition in which the cornea of the eye undergoes inflammation. Affected individuals complain of severe pain and impaired eyesight.


Presentation

Individuals with keratitis, present with the following signs and symptoms [7]:

  • Development of redness in the eyes along with pain
  • Increased discharge from the eyes
  • Increased production of tears from the eyes
  • Vision becomes blurred
  • Development of photophobia, a condition characterized by sensitivity to light
  • Decrease in vision
  • Experiencing difficulty in opening the eyes due to irritation or pain
Blurred Vision
  • Abstract A 36-year-old HIV-positive man presented with symptoms of redness, blurred vision and foreign body sensation in his right eye for 3 months.[ncbi.nlm.nih.gov]
  • One week after discontinuation of the instillation, she presented with blurred vision in her left eye with KPs and multiple stellate keratitis. The anterior chamber had no apparent cells.[ncbi.nlm.nih.gov]
  • Symptoms of keratitis include blurred vision, eye irritation or pain, glare and sensitivity to light. Treatment varies from medication to simply removing contact lenses and using preservative free artificial tears until the eye heals.[adlereyeassociates.com]
  • Keratitis is an inflammation or irritation of the cornea (the transparent membrane covering the iris and pupil) characterized by typical symptoms of red eye, foreign body sensation, pain, sensitivity to light, watery eyes, and blurred vision.[hopkinsmedicine.org]
Photophobia
  • This was accompanied with photophobia and blurring of vision after being injured by a wooden particle while cutting grass. Slit-lamp examination showed a paracentral anterior corneal stromal infiltrates with overlying epithelial defect.[ncbi.nlm.nih.gov]
  • After 4 days, he presented with pain, photophobia, tearing, and decreased vision in both eyes.[ncbi.nlm.nih.gov]
  • If the cornea is involved, early symptoms include foreign body sensation, lacrimation, photophobia, and conjunctival hyperemia.[msdmanuals.com]
  • It is characterized by photophobia due to keratitis, painful palmoplantar hyperkeratosis, variable mental retardation, and elevated serum tyrosine levels. Patients are often misdiagnosed with herpes simplex keratitis.[ncbi.nlm.nih.gov]
  • He complained decreased vision, accompanied by ocular pain, photophobia, and redness in his left eye for 7 months. Lamellar keratectomy was taken using femtosecond laser.[ncbi.nlm.nih.gov]
Eye Pain
  • Keratitis or corneal ulcer signs and symptoms include: Red eye; Eye pain; Tearing and/or discharge from your eye; Pain or irritation that makes opening your eyelid difficult; Burning, itchy or gritty feeling in your eye; Swelling around the eye; A feeling[aao.org]
  • You have severe eye pain. You have a sudden change in your vision. You suddenly lose your vision. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated.[drugs.com]
  • Eye pain and redness, excess tears, difficulty opening the eye, blurred vision, and light sensitivity can be signs of keratitis.[houstonmethodist.org]
  • pain and/or red eye should be referred promptly to an ophthalmology specialist if a diagnosis of ulcerative keratitis is confirmed, treatment with the EGFR inhibitor should be interrupted or discontinued Patients with a history of keratitis, ulcerative[gov.uk]
  • Types of bacteria that commonly cause bacterial keratitis include: Pseudomonas aeruginosa Staphylococcus aureus Symptoms of bacterial keratitis include: Eye pain Eye redness Blurred vision Sensitivity to light Excessive tearing Eye discharge If you experience[cdc.gov]
Red Eye
  • Contact lens acute red eye (CLARE) — a non-ulcerative sterile keratitis associated with colonization of Gram-negative bacteria on contact lenses. Treatment [ edit ] Treatment depends on the cause of the keratitis.[en.wikipedia.org]
  • Keratitis or corneal ulcer signs and symptoms include: Red eye; Eye pain; Tearing and/or discharge from your eye; Pain or irritation that makes opening your eyelid difficult; Burning, itchy or gritty feeling in your eye; Swelling around the eye; A feeling[aao.org]
  • You are here Home › Education › Digital Reference of Ophthalmology › Cornea & External Diseases › Infectious › Clinical features: Symptoms: irritation, red eye, photophobia nad foreign body sensation.[columbiaeye.org]
  • In the hospitalized patient with a unilateral red eye, always suspect herpes simplex keratitis. Corneal anesthesia may be present initially, minimizing pain; however, a foreign body sensation and erythema with tearing are frequently present.[infectiousdiseaseadvisor.com]
  • Common symptoms include; a painful red eye, swelling, discomfort when the child looks at light (light sensitivity or photophobia), teary watery eye or discharge, blurry vision, and the feeling of something being in the eye.[nicklauschildrens.org]
Corneal Opacity
  • Progressive, diffuse flap edema followed by pocket abscess, exudation in the anterior chamber, granulation tissue formation in the pocket, intrastromal neovascularization, and eventually partial resolution of corneal opacity were noted after topical and[ncbi.nlm.nih.gov]
  • His final visual acuity was 20/200 in the right eye and 20/60 in the left eye because of the remaining central corneal opacity. We report a first case of keratitis due to P. alcalifaciens in a chronic heavy alcohol drinker.[ncbi.nlm.nih.gov]
  • Liu, 54 percent of the patient group developed a central corneal opacity and 28 percent developed a change in their astigmatism of greater than 2 D.[reviewofophthalmology.com]
  • Herpes simplex virus (HSV) infection of the eye is a major cause of corneal opacity in the US 1 and other developed countries. 2 Infection with either HSV-1 or HSV-2 is common.[touchophthalmology.com]

Workup

A preliminary physical examination followed by careful study of the signs and symptoms should be carried out. In addition, the following tests can be employed for diagnosing keratitis [8].

  • Eye examination: The eyes should be examined for measuring visual acuity by using the standardized eye charts. Even though the individuals will experience some form of discomfort while opening the eyes for examination, such a type of test is very important and should be performed.
  • Penlight examination: Using a penlight, the size and pupil reaction should be measured.
  • Slit lamp examination: In this test, the eyes are examined using an instrument known as slit lamp. This instrument illuminates the eye to evaluate the character and extent of keratitis as well as effect on the neighboring areas of the eye.
  • Laboratory studies: In this test, sample of the tear or corneal cells are studied for the cause of keratitis. This helps in designing an appropriate treatment plan for the condition.
Penicillium
  • Corneal button culture and histopathological results confirmed the diagnosis of Penicillium marneffei keratitis. No recurrent infection occurred after corneal transplantation.[ncbi.nlm.nih.gov]
Alternaria
  • ., Staph. aureus and Acanthamoeba], Staph. aureus in 2 cases, and CoNS and Alternaria spp. in 1 case each. Resistance to fourth-generation fluoroquinolones was noted in 83.3% of cases of bacterial keratitis (n 5/6).[ncbi.nlm.nih.gov]
Capnocytophaga
  • To report our experience with 2 cases of Capnocytophaga keratitis. This is a retrospective study of case reports. We present the clinical presentation, diagnosis, and treatment strategies of 2 patients who presented with Capnocytophaga keratitis.[ncbi.nlm.nih.gov]

Treatment

  • The type of treatment employed largely depends on the type of keratitis that has set in. Treatment methods are be different for infectious and non-infectious type of keratitis. 
  • If infections are the cause of keratitis, then eye drops should be administered based on the type of organism involved. In case of bacterial infections, antibacterial drops should be advised and if viral agents are the cause, then antiviral drops along with oral medications should be administered [9] [10].
  • In cases, when keratitis is caused by the parasite acanthamoeba, antibacterial drops may be of little help. In severe cases, corneal transplant may be required. This is so because such type of infections get difficult to treat through medications and eye drops.
  • Individuals suffering from non-infectious keratitis require a 24-hour eye patch and eye drops if contact lenses are the source of cause.

Prognosis

If the condition is diagnosed in early stages and appropriate treatment is given, infections can be treated and onset of vision loss can be prevented. Failure to do so can lead to permanent scarring and long term vision loss. Severe forms of infection can also cause perforation into the cornea leading to loss of the eye.

Etiology

There are several factors that trigger an attack of keratitis. These include the following:

  • Injury: Injury to the eye can pave way for the bacteria and other organisms to gain entry causing infection. In addition, if an object penetrates the cornea or scratches the surface, the resultant irritation can favor the development of keratitis [2].
  • Contact lenses: Using contaminated contact lenses for prolonged duration can contaminate the cornea of the eye causing keratitis [3].
  • Infectious agents: Various viruses such as herpes simplex virus and herpes zoster virus can also favor inflammation of the cornea. In addition, Chlamydia infection can also lead to keratitis.
  • Contaminated water: Various types of chemicals contained in water can irritate the corneal epithelium favoring the development of keratitis.

Epidemiology

It has been estimated that about 25,000 individuals in US develop the condition of bacterial keratitis each year. Countries which are less industrialized have fewer cases of infectious keratitis owing to fact that there are less numbers of contact lens users. Severe inflammation of the cornea due to keratitis can be a cause of significant morbidity amongst the affected population [4].

Sex distribution
Age distribution

Pathophysiology

For infection to occur or for the micro organisms to gain entry into the corneal layer, there must be some kind of physical breakdown of the epithelial layer of the cornea. Such an activity paves way for development of keratitis. An injury to the eye, which causes tear in intact film of corneal epithelium favors the entry of microorganisms where they proliferate and may cause ulceration [5].

In the initial stages of the disease, the site of injury and infection undergoes swelling and necrosis. Contact lenses when worn for prolonged duration can cause the corneal epithelium to become vulnerable to attack by bacterial or viral agents [6].

Prevention

Individuals wearing contact lenses should carefully clean and disinfect their lenses prior to using them every day. Such a habit prevents the development of keratitis. In addition, taking precautionary measures while suffering from viral outbreaks also goes a long way in preventing the onset of keratitis.

Summary

Inflammation and pain in the cornea is known is keratitis. Infections and injuries to the eye along with underlying disease conditions can cause keratitis. Mild to moderate cases of keratitis can be easily treated; however, if the condition is left untreated, there can be permanent loss of vision. Individuals suffering from keratitis can experience itchiness in the eyes each time they blink. There are several forms of keratitis depending on the causative factor. Infectious type of keratitis is caused due to bacteria, viruses and fungi. The non-infectious variety is caused due to injury or underlying disease conditions [1].

Patient Information

Keratitis is a condition, wherein there is inflammation of the cornea of the eye. Infections, physical injury and underlying disease conditions are the cause of keratitis. Individuals wearing contact lenses for prolonged duration are at an increased risk of developing the condition. Affected individuals suffer from redness of the eyes accompanied by pain and irritation. There is increased discharge from the affected eye and blurring of vision. Individuals often experience difficulty in opening their eyes due to pain and irritation.

The treatment depends on the cause of keratitis. If bacterial infections are the cause, then antibiotics drops along with medications form the basis of treatment. If parasitic infections are the cause, then corneal transplant may be required. For contact lens wearer, 24-hour eye patch is required.

References

Article

  1. Forster RK. Conrad Berens Lecture. The management of infectious keratitis as we approach the 21st century. CLAO J 1998; 24:175.
  2. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review. Ophthalmology. Jul 1999;106(7):1313-8.
  3. Liesegang TJ. Contact lens-related microbial keratitis: Part I: Epidemiology. Cornea 1997; 16:125.
  4. Dart JK. Eye disease at a community health centre. Br Med J (Clin Res Ed) 1986; 293:1477.
  5. Hirst LW, Smiddy WE, Stark WJ. Corneal perforations. Changing methods of treatment, 1960--1980.Ophthalmology. Jun 1982;89(6):630-5.
  6. Dart JK, Radford CF, Minassian D, et al. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology 2008; 115:1647.
  7. Leibowitz HM. The red eye. N Engl J Med 2000; 343:345.
  8. Varma R, eds. Cornea/external diseases. Essentials of Eye Care: The Johns Hopkins Wilmer Handbook. Lippincott Williams & Wilkins;1997:152-203.
  9. Stern GA, Schemmer GB, Farber RD. Effect of topical antibiotic solutions on corneal epithelial wound healing. Arch Ophthalmol. Apr 1983;101(4):644-7.
  10. Ray KJ, Srinivasan M, Mascarenhas J, et al. Early addition of topical corticosteroids in the treatment of bacterial keratitis. JAMA Ophthalmol 2014; 132:737.

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Last updated: 2019-07-11 22:39