interstitial Keratitis

interstitial keratitis

1. INTERSTITIAL KERATITIS BALAJI S

2. 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.

3. Causes Congenital syphilis TB Cogan’s syndrome Acquired syphilis Trypanosomiasis Leprosy Malaria

4. Syphilitic interstitial keratitis CONGENITAL ACQUIRED More common 90% Less common Bilateral Unilateral Age - (5 – 15 ) yrs Any age

5. P athogenesis T.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

6. symptoms Pain Lacrimation Photophobia Blurring of vision Blepharospasm

7. Clinical features Hutchinson’s triad – congenital syphilis

8. S tages Initial progressive stage Florid stage Stage of regression

9. 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

10. 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 .

11. 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.

12. Diagnosis Corneal haze & other typical findings on slit lamp examination. Serology - VDRL - T.pallidum immobilisation test - micro haemagglutination assay - fluorescent Ab absorption test

13. 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

14. SYSTEMIC - high doses of penicillin to prevent further development of lesions - systemic steroids can be given in refractory cases.

15. 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

16. 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.

17. Treatment Urgent evaluation is indicated because early treatment prevents permanent deafness & blindness. Systemic & topical corticosteroids.

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