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interstitial Keratitis

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interstitial keratitis

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interstitial Keratitis

  1. 1. INTERSTITIAL KERATITIS BALAJI S
  2. 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. 3. Causes  Congenital syphilis  TB  Cogan’s syndrome  Acquired syphilis  Trypanosomiasis  Leprosy  Malaria
  4. 4. Syphilitic interstitial keratitis CONGENITAL ACQUIRED More common 90% Less common Bilateral Unilateral Age - (5 – 15 ) yrs Any age
  5. 5. Pathogenesis 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. 6. symptoms • Pain • Lacrimation • Photophobia • Blurring of vision • Blepharospasm
  7. 7. Clinical features  Hutchinson’s triad – congenital syphilis Interstitial keratitis Hutchinson’s teeth Vestibular deafness
  8. 8. Stages  Initial progressive stage  Florid stage  Stage of regression
  9. 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. 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. 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. 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. 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. 14. SYSTEMIC - high doses of penicillin to prevent further development of lesions - systemic steroids can be given in refractory cases.
  15. 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. 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. 17. Treatment • Urgent evaluation is indicated because early treatment prevents permanent deafness & blindness. • Systemic & topical corticosteroids.
  18. 18. Thank You

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