INTERSTITIAL KERATITIS BALAJI S
INTERSTITIAL KERATITIS
BALAJI S
Definition
Non ulcerative inflammation of corneal stroma without primary involvement of epithelium and endothelium.
It is mostly allergic in origin and may be infective also.
CausesCongenital syphilisTBCogan’s syndromeAcquired syphilisTrypanosomiasisLeprosyMalaria
Syphilitic interstitial keratitis
CONGENITAL ACQUIRED
More common 90% Less common
Bilateral Unilateral
Age - (5 – 15 ) yrs Any age
PathogenesisT.pallidum invades & sensitizes cornea during foetal stage
later the exposure to either treponema or its toxin
Inflammation of the sensitized cornea due to local Ag - Ab reaction
symptoms
• Pain• Lacrimation• Photophobia • Blurring of vision• Blepharospasm
Clinical features Hutchinson’s triad – congenital
syphilisInterstitialkeratitis
Hutchinson’s teeth
Vestibular deafness
Stages
Initial progressive stageFlorid stageStage of regression
Initial progressive stage
• One or more Hazy patches appear in the deep layers of the stroma.
• Associated with uveitis ( iritis , cyclitis , choroiditis )
• Presence of keratic precipitates.• Diffuse corneal haze – ground glass
appearance• Lasts for about 2 weeks
Florid stage ( 2 months )
Deep vascularization of the cornea – radial bundle of brush like vessels.
Salmon patch appearance due to the haziness of cornea.
May be moderate degree of superficial vascularization.
Vessels & conjunctiva appears heaped at the limbus.
Stage of regression
• Corneal haze resolves slowly & begins from periphery towards centre.
• As cloudiness disappears , the vessels become obliterated & they remain permanently as fine opaque lines ( ghost vessels ).
• Lasts for about 1 – 2 yrs.
DiagnosisCorneal haze & other typical findings
on slit lamp examination.Serology - VDRL - T.pallidum immobilisation test - micro haemagglutination assay - fluorescent Ab absorption test
Treatment LOCAL - topical corticosteroid drops ( 0.1% ) every 2-3 hrs - atrophine eye ointment 1% 2 – 3 times/day - dark googles for photophobia - penetrating keratoplasty
SYSTEMIC
- high doses of penicillin to prevent further development of lesions
- systemic steroids can be given in refractory cases.
TB INTERSTITIAL KERATITIS
Features similar to syphilitic keratitis except that it is frequently unilateral & involves mostly lower sector of cornea.
Treatment systemic - anti TB drugs Topical - steroids & cycloplegics
Cogan’s syndrome• A rare autoimmune disease of eye
& inner ear.• Common in young adults.• May be associated with severe
vasculitis.
Features - vertigo , tinnitus & deafness. - bilateral (IK) , uveitis & blindness.
Treatment • Urgent evaluation is indicated
because early treatment prevents permanent deafness & blindness.
• Systemic & topical corticosteroids.
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