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Corneal Disorder – Keratitis

Keratitis is a condition in which the eye’s cornea, the front part of the eye, becomes inflamed. The condition is often marked by moderate to intense pain and usually involves impaired eyesight.
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Anatomy of Eye

TYPES

  • Superficial keratitis involves the superficial layers of the cornea. After healing, this form of keratitis does not generally leave a scar.
  • Deep keratitis involves deeper layers of the cornea, and the natural course leaves a scar upon healing that impairs vision if on or near the visual axis. This can be reduced or avoided with the use of topical corticosteroid eyedrops.

    CAUSES

    • Keratitis has multiple causes, one of which is an infection of a present or previous herpes simplex virus secondary to an upper respiratory infection, involving cold sores.
    • Amoebic keratitis. Amoebic infection of the cornea is the most serious corneal infection, usually affecting contact lens wearers. It is usually caused by Acanthamoeba.
    • Bacterial keratitis. Bacterial infection of the cornea can follow from an injury or from wearing contact lenses. The bacteria involved are Staphylococcus aureus and for contact lens wearers, Pseudomonas aeruginosa. Pseudomonas aeruginosa contains enzymes that can digest the cornea.
    • Fungal keratitis .Filamentous fungi are most frequently the causative organism for fungal keratitis.
    • Onchocercal keratitis, which follows O. volvulus infection by infected blackfly bite. These blackfly usually dwell near fast-flowing African streams, so the disease is also called “river blindness”.

    DIAGNOSIS

    Effective diagnosis is important in detecting this condition and subsequent treatment, as keratitis is sometimes mistaken for an allergic conjunctivitis.

    TREATMENT

    Treatment depends on the cause of the keratitis. Infectious keratitis generally requires antibacterial, antifungal, or antiviral therapy to treat the infection. This treatment can involve prescription eye drops, pills, or even intravenous therapy. Over-the-counter eye drops are typically not helpful in treating infections. In addition, contact lens wearers are typically advised to discontinue contact lens wear and discard contaminated contact lenses and contact lens cases.

    Antibacterial solutions include levofloxacin, gatifloxacin, moxifloxacin, ofloxacin. Steroid containing medications should not be used for bacterial infections, as they may exacerbate the disease and lead to severe corneal ulceration and corneal perforation. These include Maxitrol (neomycin+polymyxin+dexamethasone — available generically), as well as other steroid medications. One should consult an ophthalmologist or optometrist for treatment of an eye condition.

    Some infections may scar the cornea to limit vision. Others may result in perforation of the cornea, (an infection inside the eye), or even loss of the eye. With proper medical attention, infections can usually be successfully treated without long-term visual loss.