Interstitial keratitis

Interstitial keratitis
Specialty	Ophthalmology

Interstitial keratitis (IK) is an eye disorder characterized by scarring of the cornea due to chronic inflammation of the corneal stroma (keratitis). "Interstitial" refers to space between cells (i.e. the corneal stroma, which lies between the epithelium and the endothelium).

Signs and symptoms

Acutely, early symptoms include a painful, photophobic, red watery eye. This is due to active corneal inflammation resulting in vascular invasion and stromal necrosis which can be diffuse or localized. This causes the pinkish discoloration of what was a clear transparent normal corneal tissue (called Salmon patch of Hutchinson).^{[citation needed]}

Such vascularization is likely to result in blurring of vision secondary to corneal stromal scarring, the presence of ghost vessels, and thinning of the cornea, especially if it involves the visual axis.^{[citation needed]}

Cause

By far the most common cause of IK is syphilitic disease. However, there are two possible causes of the corneal inflammatory response: an infection and/or an immunological response, such as a hypersensitivity type reaction, or (rarely) Cogan syndrome.^[1] Infectious causes include syphilis (commonest), followed by other bacterial infections (TB, Leprosy and Lyme disease) and parasitic infections (Acanthamoeba, Onchocerciasis or river blindness, Leishmaniasis, Trypanosoma cruzi or Chagas disease, Trypanosoma brucei or African sleeping sickness and microsporidia)^[2]

Pathophysiology

The corneal scarring is the result of the initial invasion of blood vessels into the corneal stroma as part of the inflammatory response. Since normal corneal tissue should be avascular (no blood vessel) and therefore clear to allow light to pass, the presence of blood vessel and the infiltration of cells as part of the inflammatory process results in scarring or hazing of the cornea.^[3]

Diagnosis

A positive VDRL of Treponema pallidum immobilization test confirms diagnosis of luetic(syphilitic) interstitial keratitis^{[citation needed]}

Treatment

The underlying cause must be treated as soon as possible to stop the disease process. Corticosteroid drop can be used to minimize the scarring on the cornea along with antibiotic cover. However, residual scarring cannot be avoided which can result in long term visual impairment and corneal transplantation is not suitable due to high rejection rate from the corneal vascularization.^[4]

History

Previous long-standing eye infection which possibly during childhood time recalled as being treated with antibiotic and/or hospitalized over long period of time.^{[citation needed]}

References

1. Ramachandran, Tarakad. "Cogan Syndrome". Medlink. MedLink Corporation. Archived from the original on 9 March 2016. Retrieved 11 January 2012.
2. Majmudar PA. "Keratitis, Interstitial" emedicine Dec 2007
3. Dr Khairul Nazri Mohammad (Articles' Author), Waterford General Hospital, IRELAND
4. Kanski JJ. "Clinical Ophthalmology 5th ed"