This document discusses interstitial keratitis, an inflammation of the corneal stroma without primary involvement of the epithelium or endothelium. It can be caused by antigen-antibody complex deposition, complement-mediated disease, or delayed type hypersensitivity reactions from viruses, bacteria, or other causes like sarcoidosis. There are three main types - syphilitic, tuberculous, and Cogan's syndrome. Syphilitic interstitial keratitis is a late manifestation of congenital syphilis and has three stages: initial progressive, florid, and regression. It is treated with topical medications for keratitis and systemic treatment for syphilis. Tuberculous keratitis is

1. Interstitial keratitis
Gauri shankar Saini
MBBS

2. Introduction
• Inflammation of corneal stroma without primary involvement of
epithelial and endothelium
• Non suppurative inflammation
• Characterized by cellular infiltration of corneal stroma

3. Aetiology
• Antigen antibodies complex deposition
• Complement mediated disease
• Delayed type hypersensitivity reaction
• Viral:-- HSV,EBV, Herpes zooster, mumps, measles
• Bacterial :- TB, syphilis
• Others :-- sarcoidosis,cogan syndrome,RA, malaria

4. Types of interstitial keratitis
1. Syphilitic
2. Tuberculous
3. Cogan syndrome

5. Syphilitic interstitial keratitis
• Congenital (90%):- manifestation develop btw 5-15 yrs
• Bilateral (inherited syphilis)
• Unilateral (acquired)

6. Pathogenesis
• It is a manifestation of local antigen antibodies reaction
• It is triggered by injury and operations
• Presumed that trepanoma pallidum invades the cornea and sensitizes
it ( foetal stage)
• Later its toxin excites the information of sensitized cornea

7. Clinical features
• Late manifestation of congenital syphilis
• Hutchinsons triad:- interstitial keratitis
. Hutchinson teeth
. Vestibular deafness
• Its are divided into three stages
1. Initial progressive
2. Florid stage
3. Stages of regression

8. 1. Initial progressive stage
• Begins with oedema of the endothelium and deeper stroma,
secondary to anterior uveitis
• Associated with:- pain,lacrimation, photophobia, blepharospasm,
ground glass appearance of cornea dt circumcorneal injection
• Lasts for about 2 weeks

9. 2. Florid stage
• Eyes remain acutely inflamed
• Deep vascularization of cornea (radial bundle of brush like)
• Vessels covered by hazy cornea
• Salmon patch appearance ( dull reddish pink)
• Moderate degree of vascularization arising from terminal branches of
conjuctival vessels over cornea for short distance
• Epulit (lump) vessels with conjuctiva at limbus
• Lasts for about 2 months

10. 3. Stage of regression
• Acute inflammation resolve
• Progressive appearance of vascular invasion
• Slow clearing of cornea (periphery to central)
• Some opacity and ghost vessels after resolution of the lesion
• Lasts for about 1-2 yrs

11. Diagnosis
• VDRL
• Trepanoma pallidum immobilisation test

12. Treatment
• Topical treatment for keratitis
• Sysyemic treatment for syphilis
• Local :- dexamethasone, atropine eye ointment,dark goggles,
keratoplasty
• Systemic treatment:- penicillin, systemic steroids

13. Tuberculous keratitis
• More frequently
• Unilateral and sectorial (lower sector of cornea)
• Treatment:- antitubercular drugs, topical steroids,cycloplegics

14. Cogans syndrome
• Comprises of interstitial keratitis, acute tinitis,vertigo, deafness
• Occurs in middle age adults
• Bilateral
• Treatment:- topical and systemic steroids