Miscellaneous keratitis 09.03.16,dr.k.jha

1. Dr K N Jha,MS
Professor of Ophthalmology
Email: kirtinath.jha@gmail.com

2. Interstitial keratitis
 It is an inflammation affecting chiefly the stroma of
the cornea.
 Cause : infectious or autoimmune.
 Infections: syphilis, M. leprae and tuberculosis, EB
virus, Lyme disease, sarcoidosis, Cogan syndrome,
mumps and rubeola keratitis, Chlamydia, LGV,
Acanthamoeba, Leishmania.

3. Interstitial Keratitis due to syphilis
 Majority are due to congenital syphilis, with
bilateral involvement in 80% cases.
 Acquired adult syphilis produces IK much less
frequently, and it is unilateral.

4. Clinical features
 Pain, CCC, lacrimation, photophobia, and
blepharospasm
 Diffuse corneal haze ( Nonulcerative stromal keratitis
)and neovascularization, uveitis.
 Acute inflammatory edema resolves with the
progressive vascular invasion
 Deep opacities and ghost vessels
 Hearing impairment and chorioretinal scarring

6. Management
 Diagnosis is confirmed with blood tests: FTA-ABS or MHA-
Treponema pallidum (MHA-TP)
 Follow-up with VDRL
 Test also for HIV
 Treat syphilis on usual lines.
 Topical steroid therapy: Prednisolone 1% qid to 8id for 1 m
to 2 m then tapered.
 Cycloplegics

8. Exposure Keratopathy
 Exposure keratopathy can result from any disease that
limit eyelid closure
 VII nerve palsy, cicatricial ectropion, Parkinson
disease, proptosis, comatose patients

9. Lagophthalmos

10. Clinical features
 Punctate epithelial keratopathy involving lower third
of the cornea
 May involve whole of the cornea in ulceration, melting
and perforation
 Symptoms of corneal ulcer unless cornea is anaesthetic

11. Management of Exposure
Keratopathy
 Medical therapy: non-preserved tear substitute, eye
ointment and taping of eyelids at night.
 Surgical therapy:
- Lateral tarsorrhaphy
- Insertion gold or platinum weight in the upper eyelid

12. Neurotrophic Keratopathy
 Neurotrophic keratopathy results from damage to
cranial nerve V
 Etiology: Surgery, CVA, Viral infections of
cornea,topical medications, Hansen disease

13. Clinical features
 Usually involves central or inferior paracentral
cornea
 Sterile persistent epithelial defect with rolled
up, elevated edges
 May lead to ulceration, perforation and loss of
eye

14. Neurotrophic ulceration

15. Management
Treat the cause and treat lagophthalmos
Topical tear substitute, and eye ointment
Tetracycline and Medroxyprogesterone ointment
Autologous serum drop
Bandage contact lenses
Amniotic membrane grafting.

16. Points to remember
 Interstitial Keratitis
 Neurotrophic keratitis
 Lagophthalmos: Cause, complication and
Treatment