INTERSTITIAL KERATITIS

BALAJI S

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.

CausesCongenital syphilisTBCogan’s syndromeAcquired syphilisTrypanosomiasisLeprosyMalaria

Syphilitic interstitial keratitis

CONGENITAL ACQUIRED

More common 90% Less common

Bilateral Unilateral

Age - (5 – 15 ) yrs Any age

PathogenesisT.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

symptoms

• Pain• Lacrimation• Photophobia • Blurring of vision• Blepharospasm

Clinical features Hutchinson’s triad – congenital

syphilisInterstitialkeratitis

Hutchinson’s teeth

Vestibular deafness

Stages

Initial progressive stageFlorid stageStage of regression

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

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.

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.

DiagnosisCorneal haze & other typical findings

on slit lamp examination.Serology - VDRL - T.pallidum immobilisation test - micro haemagglutination assay - fluorescent Ab absorption test

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

SYSTEMIC

- high doses of penicillin to prevent further development of lesions

- systemic steroids can be given in refractory cases.

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

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.

Treatment • Urgent evaluation is indicated

because early treatment prevents permanent deafness & blindness.

• Systemic & topical corticosteroids.

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