Keratitis

What is Keratitis?

Keratitis is an inflammation of the clear front layer of the eye called the cornea. Herpes simplex keratitis is one of the most common types of keratitis seen currently. Other causes of keratitis include exposure to air or ultraviolet light, susceptibility to infection (immunosuppressed state), use of corticosteroid eye drops, infection, contact lens overwear and vitamin A deficiency.

How is it diagnosed?

History: The individual may report irritation, tearing, light sensitivity and blurred vision. Severe pain that increases with eye or lid movement may or may not be present. There may be a history of eye trauma or previous herpes fever blisters.

Physical exam: The eye may have redness of the sclera or conjunctiva. It may be possible to see scratches or cell deposits on the cornea with a light, however staining with fluorescein dye and the use of a slitlamp will cause these areas to glow. An anesthetic eye drop may be used to make examination tolerable. The blood vessels of the iris may be enlarged (dilated).

Tests: Visual acuity testing will be done. Cell deposits on the cornea may be removed and cultured to determine the type of infection.

How is it treated?

Treatment must begin without delay. If exposure or lens overwear is the cause, it may be treated by applying ointment and patching the eyes. For infection, cell deposits containing the infectious agent may be removed with a cotton applicator. Antibiotic and cycloplegic eye drops are then applied and a pressure dressing is placed over the eye. Daily treatment may be required. Vitamin A is prescribed when deficiency is the culprit. Antibiotic or antiviral medication may be given by mouth.

Medications

Information

Brand

Generic

Label

Deltasone

Prednisone

Decadron (Dexamethasone), Aristocort (Triamcinolone)

Staphylococcus keratitis

Cipro

Ciprofloxacin

What might complicate it?

Keratitis of any type can progress to the corneal ulcer state. Infection can spread to other eye structures. It will be more difficult to treat if the individual is immunosuppressed or if corticosteroids must be used to control inflammation.

Predicted outcome

In those with a normal immune status, keratitis may be self-limiting and result in little or no scarring or visual decrease. In those of an immunosuppressed status, keratitis can result in severe scarring, infection of the entire eye (panophthalmitis), glaucoma, cataract, corneal melting and perforation, especially if corticosteroids must be used. Decreased vision or blindness could result making a corneal transplant necessary. Herpes simplex keratitis normally recurs periodically but can become chronic and damaging in these individuals.

Alternatives

Anterior uveitis, conjunctivitis, acute glaucoma, corneal abrasion or foreign body, or corneal ulcer may present with similar symptoms.

Appropriate specialists

Ophthalmologist.

Last updated 4 April 2018