miscellaneous keratitis 09.03.16,dr.k.jha
TRANSCRIPT
Interstitial keratitis ( IK)Dr K N Jha,MS
Professor of OphthalmologyEmail: [email protected]
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