Keratitis

Keratitis is a condition that affects the cornea, the transparent, dome-shaped window that covers the front of the eye. It is characterised by inflammation of the cornea, which can lead to various symptoms such as eye pain, redness, blurred vision, and sensitivity to light. If left untreated, keratitis can cause permanent damage to the cornea and even result in corneal blindness, making it crucial to seek prompt medical attention if you suspect you may have this condition.

What is Keratitis?

Keratitis, also known as corneal inflammation or corneal ulcer, can be caused by a variety of factors. Infectious keratitis is caused by microorganisms such as bacteria, viruses, fungi, or parasites, while noninfectious keratitis can be triggered by injuries, dry eye syndrome, eyelid disorders, or exposure to ultraviolet light. Common symptoms of keratitis include eye pain, redness, blurred vision, sensitivity to light, and a sensation of something being stuck in the eye. Prompt diagnosis and treatment of keratitis are essential to prevent the condition from worsening and potentially causing permanent vision loss.

Keratitis, a condition characterized by corneal inflammation, can be broadly classified into two main categories: infectious and non-infectious. Let's delve into the details of these different types of keratitis.

Infectious Keratitis

Infectious keratitis is caused by various microorganisms, including bacteria, fungi, viruses, and protozoa. Here are the main types of infectious keratitis:

• Bacterial Keratitis: This type of keratitis is caused by bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, Neisseria gonorrhoeae, and Haemophilus influenzae. It often develops in people who use contact lenses improperly, leading to an increased risk of eye infection.

• Fungal Keratitis: Fungal keratitis is caused by fungi such as Aspergillus, Candida, Fusarium, and Pythium insidiosum. It is often associated with contact with plant material or the use of contaminated contact lens care solutions.

• Viral Keratitis: Viral keratitis is primarily caused by the herpes simplex virus (HSV), which can progress from conjunctivitis to keratitis. Other viruses like adenovirus types 8, 19, and 37 can also cause this type of corneal inflammation.

• Protozoal Keratitis: Protozoal keratitis is caused by Acanthamoeba, a single-celled organism. It is often associated with inadequate hygiene when using contact lenses and exposure to contaminated water.

Prompt diagnosis and appropriate treatment are crucial in managing infectious keratitis to prevent severe complications and permanent vision loss. Treatment options vary depending on the causative organism and may include antibiotics, antifungals, or antivirals.

Non-infectious Keratitis

Non-infectious keratitis refers to corneal inflammation that is not caused by microorganisms. Several factors can contribute to the development of non-infectious keratitis, including:

• Local Causes: These include trichiasis (inward-turning eyelashes), giant papillae, foreign bodies in the sulcus subtarsalis (the space between the eyelid and the eyeball), and conditions like xerophthalmia (dry eyes).

• Peripheral Ulcerative Keratitis: This type of keratitis is associated with collagen vascular diseases such as rheumatoid arthritis, granulomatosis with polyangiitis, and systemic lupus erythematosus.

• Neurotrophic Keratitis: Neurotrophic keratitis occurs due to damage to the trigeminal nerve, which can be caused by post-herpes zoster ophthalmicus (shingles affecting the eye area) or surgery or tumors affecting the nerve.

• Exposure Keratitis: This type of keratitis is caused by dryness and damage to the cornea due to inadequate tear film or improper eyelid function.

• Filamentary Keratitis: Filamentary keratitis is characterized by strands of epithelial tissue and mucus on the cornea and is often associated with dry eyes or corneal swelling.

• Interstitial Keratitis: This type of keratitis involves inflammation of the middle layers of the cornea and often affects children and adolescents who have had congenital syphilis.

• Marginal Keratitis: Marginal keratitis inflames the outer edge of the cornea and is often triggered by bacterial staphylococcus infections.

The treatment for non-infectious keratitis depends on the underlying cause. It may involve addressing the local factors, treating the associated systemic conditions, or using medications to manage inflammation and promote healing.

In conclusion, keratitis can manifest in various forms, each with its unique causes and characteristics. Recognizing the different types of keratitis is essential for accurate diagnosis and appropriate treatment. If you suspect that you have keratitis or experience any concerning symptoms, such as eye pain, redness, or vision changes, it is crucial to consult an eye care professional promptly to prevent complications and safeguard your vision.

In addition to the general symptoms mentioned above, there are some early signs of keratitis that you should be aware of:

• Sudden onset of severe eye pain

• Increased sensitivity to light

• Redness of the eye

• Swelling of the eyelids

• Mucopurulent discharge in the conjunctival sac

• Decreased visual acuity

If you notice any of these early signs, it is crucial to seek medical attention immediately. Prompt keratitis diagnosis and treatment can help prevent the development of corneal ulcers and other serious complications.

The symptoms of keratitis can vary depending on the underlying cause, but some common signs include:

• Excessive tearing

• Eye discharge

• Inability to open the eye

• Pain and irritation in the affected eye

• Red eyes

• Sensitivity to light (photophobia)

• Vision changes, such as blurriness or inability to see

Keratitis, an inflammation of the cornea, can be caused by various factors that are classified as infectious or non-infectious. Infectious keratitis is commonly caused by bacteria such as Staphylococcus, Streptococcus, and Pseudomonas, especially in contact lens wearers who do not properly clean and disinfect their lenses or cases. Viral infections like herpes simplex virus, herpes zoster virus, or the common cold can also lead to keratitis if the eye is touched after contact with an infected area. While rare, fungal infections may occur due to contamination from plant material or improper contact lens use. Parasitic infections, typically caused by Acanthamoeba found in water and soil, are more common in contact lens wearers who swim or shower while wearing their lenses.

Non-infectious keratitis can result from injuries such as scratches, scrapes, or cuts to the cornea, as well as from wearing contact lenses improperly, dry eye syndrome, eyelid disorders, and exposure to intense UV light. Understanding these various causes of corneal inflammation is crucial for preventing and effectively treating keratitis.

Several factors can increase an individual's likelihood of developing keratitis:

• Contact lens wear, especially sleeping in extended-wear lenses, improper disinfection, and wearing lenses while swimming

• Reduced immunity due to conditions like HIV/AIDS or medications that suppress the immune system

• Corneal injury or trauma

• Eyelid disorders that prevent proper eyelid function and lead to corneal dryness

• Exposure to contaminated water, such as in hot tubs or swimming pools

• Vitamin A deficiency, which is rare in developed countries but more common in areas with malnutrition

Identifying and addressing these risk factors can help prevent the onset of keratitis or reduce the severity of symptoms if the condition does occur.

If left untreated or if treatment is delayed, keratitis can lead to serious complications:

• Corneal ulceration, which is an open sore on the cornea that can cause severe pain and vision problems

• Corneal scarring that can permanently impair vision

• Chronic corneal inflammation

• Corneal neovascularization, where new blood vessels grow into the typically avascular cornea, potentially causing vision loss

• Corneal perforation, a hole in the cornea that can lead to severe infection and permanent vision loss

• Endophthalmitis, a rare but severe infection of the entire eye interior that can cause blindness

To prevent keratitis, several key measures can be taken, particularly for contact lens wearers:

• Proper Contact Lens Care: Follow the schedule for wearing the lenses and follow the care regimen prescribed by your eye doctor. Avoid wearing them while swimming, showering, or engaging in activities that expose the eyes to water.

• Cleanliness: Wash your hands thoroughly with soap and water before handling contact lenses or touching your eyes. Ensure your hands are completely dry before handling lenses or eyes.

• Storage and Cleaning: Use fresh solution to clean and store contact lenses. Keep the storage case clean and germ-free, and replace it every 3 to 6 months. Never store contact lenses in tap water or saliva.

• General Hygiene: Avoid touching your eyes if you have a cold sore, herpes blister, or any other infection. Frequent hand washing can help reduce the risk of viral outbreaks.

• Eye Protection: Wear proper eye protection such as sunglasses in bright sunlight, safety goggles when working with chemicals or sharp objects, and avoid exposure to UV light without protection.

• Immune System Health: Maintain a healthy immune system, as a weakened immune system can increase the risk of developing keratitis.

• Regular Check-ups: Regularly visit your eye doctor to monitor the health of your eyes and address any symptoms promptly.

By following these preventive measures, you can significantly reduce your risk of developing keratitis, an eye infection characterised by corneal inflammation.

If you experience keratitis symptoms such as eye pain, redness, blurred vision, or increased sensitivity to light, it is essential to seek prompt medical attention. Diagnosing keratitis involves several steps:

• Patient History: Your eye doctor will take a detailed history of your symptoms and any general health problems that may be contributing to the eye issue.

• External Examination: An external examination of the eye using a biomicroscope (slit-lamp) will be performed to examine the cornea and other structures of the eye. A stain such as fluorescein dye may be applied to determine the extent of the keratitis.

• Laboratory Analysis: In some cases, tears or corneal cells may be collected and sent to a lab for analysis to determine the pathogen causing the infection, particularly in cases of infectious keratitis.

The treatment of keratitis depends on the cause of the corneal inflammation or infection.

Infectious Keratitis:

• Bacterial Keratitis: Treated with antibiotic eye drops, and in severe cases, oral antibiotics may be prescribed.

• Fungal Keratitis: Treated with antifungal medications, which may include eye drops, oral medications, or, in severe cases, intravenous antifungal therapy.

• Viral Keratitis: Antiviral medications may be prescribed in the form of eye drops or oral medications. In some cases, such as herpes simplex keratitis, long-term antiviral treatment may be necessary to prevent recurrence.

Non-infectious Keratitis:

• Neurotrophic Keratitis: Treatment focuses on promoting healing of the corneal surface, which may involve the use of artificial tears, lubricating ointments, or special contact lenses. In severe cases, surgical intervention may be necessary.

• Autoimmune Keratitis: Treatment typically involves the use of corticosteroid eye drops to reduce inflammation and suppress the immune response. In some cases, systemic immunosuppressive medications may be necessary.

In all cases of keratitis, close monitoring by an eye care professional is essential to ensure proper healing and to prevent complications such as corneal scarring or vision loss. Prompt treatment and adherence to the prescribed management plan are crucial for the best possible outcome.

If you have been diagnosed with keratitis, it is essential to follow your eye doctor's instructions carefully to ensure proper treatment and recovery. The specific treatment for keratitis will depend on the underlying cause of the condition and its severity. For infectious keratitis, treatment may involve the use of antibiotic, antiviral, or antifungal eye drops, and in more severe cases, oral medication may be necessary. Noninfectious keratitis treatment may include artificial tears, anti-inflammatory eye medication, and the use of a bandage to shield the affected eye. To prevent the development of keratitis, it is crucial to practice good contact lens hygiene and to seek medical attention immediately if you experience any symptoms of eye infection or corneal inflammation.

If you experience any symptoms of keratitis, such as eye pain, redness, blurred vision, sensitivity to light, excessive tearing, or discharge, it is important to seek medical attention promptly. This is especially crucial if you wear contact lenses, as delaying treatment can lead to severe complications. If you suspect an eye infection or have a sudden change in vision, remove your contact lenses (if applicable) and consult an eye care professional immediately. Early diagnosis and treatment of keratitis are key to preventing permanent damage to your cornea and preserving your vision. Remember, when it comes to your eye health, it is always better to err on the side of caution and seek professional advice.

• Keratitis is a serious inflammatory condition of the cornea that can lead to sight-threatening complications if left untreated.

• Immediate medical attention is necessary if symptoms of keratitis appear.

• Proper hygiene and care of contact lenses can significantly reduce the risk of developing infectious keratitis.

• Early detection and prompt treatment of keratitis are essential for preserving vision and preventing long-term complications.