Keratitis - What Is It? Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Keratitis: types, symptoms and treatment

The cornea of the eye is one of the most vulnerable structural elements of the organ of vision. The cornea is influenced by light, ambient temperature and a number of other factors. Sometimes the cornea is attacked by pathogenic flora. Its mechanical damage also occurs. Therefore, keratitis, that is, inflammation of the cornea, is often diagnosed by ophthalmologists.

Symptoms of keratitis are discomfort in the eyes, the appearance of ulcerative defects on their mucous membrane. A person develops photophobia, lacrimation increases. If there is no treatment, then serious complications can develop, up to blindness and the formation of a leucorrhoea. Therefore, you need to start treating keratitis immediately.

Content:

• What is keratitis?
• Keratitis reasons
• Classification of keratitis
• Keratitis symptoms
• Separate forms of keratitis
• Diagnosis of keratitis
• Keratitis treatment
• Complications
• Forecast and prevention

What is keratitis?

Keratitis is an inflammation of the cornea of the eye. Due to this pathological process, corneal opacity occurs. The eyeball itself often acquires a red color, which is due to the expansion of the vessels of the perilimbal region.

Often the cause of keratitis is an inflammatory process, such as conjunctivitis or blepharitis. Bacteria affect the cornea, including representatives of the coccal flora, amoeba, Pseudomonas aeruginosa, etc. The viral and fungal nature of keratitis cannot be ruled out. However, mycotic organisms lead to inflammation of the cornea less often than the rest of the pathogenic flora.

People who use contact lenses are prone to keratitis. Such persons need to be especially careful about observing the rules of personal eye hygiene.

Keratitis is an occupational disease of welders. Their organs of vision are regularly affected by exposure to ultraviolet radiation. It is an additional risk factor for the development of corneal inflammation.

If there is no treatment for keratitis, then a thorn is formed in the affected area, which causes visual impairment. When therapy is timely and fully implemented, the prognosis is favorable. Most often, complete recovery is achieved. However, with long-term current keratitis, irreversible loss of vision can occur, up to complete blindness.

Keratitis reasons

The reasons that can provoke keratitis can be very diverse. They are divided into internal and external. Most often, it is not difficult to determine them; idiopathic keratitis is rarely diagnosed.

External reasons that can lead to the development of keratitis include:

• Mechanical eye injury.
• Chemical damage to the eyeball.
• Thermal injury.
• Previous eye infections, such as syphilitic or tuberculous keratitis.
• Fungal corneal disease.
• Bacterial infections that are most often caused by staphylococci and Pseudomonas aeruginosa.
• Wearing contact lenses.
• Excessive influence of ultraviolet radiation on the cornea of the eye.

Internal reasons that lead to the development of keratitis include:

• Damage to the nervous system with deterioration of the innervation of the organs of vision.
• Deficiency of vitamins in the body.
• Allergy.
• Viral infections. This refers to the herpes that a person has been infected with.
• Metabolic disruptions.
• Conjunctivitis and eyelid diseases.
• Corneal erosion.
• Lagophthalmos, which consists in incomplete closure of the eyelids.
• Systemic diseases, in particular diabetes mellitus, rheumatism and gout.

Rarely, the cause of keratitis cannot be established.

Classification of keratitis

Depending on the cause of the corneal inflammation, keratitis of the following types is distinguished:

1. Exogenous keratitis that develop under the influence of external factors:

   • Traumatic inflammation. It can be caused by physical, mechanical, or chemical injury.
   • Purulent inflammation that develops due to damage to the cornea by bacteria, fungi or viruses.
   • Keratitis that occurs against the background of inflammation of the meibomian glands, or against the background of diseases of the conjunctiva.

2. Endogenous keratitis that develop for internal reasons:

   • Infectious keratitis provoked by the herpes virus, mycobacterium tuberculosis, brucellosis, malaria, or leprosy.
   • Non-infectious keratitis, which develops against the background of systemic damage to the connective tissues.
   • Neuroparalytic keratitis.
   • Hypo- and avitaminous keratitis associated with a lack of vitamins in the body.
   • Allergic keratitis, which is caused by an allergic reaction of the body.
3. Keratitis with an unexplained etiological factor. This includes rosacea keratitis, filamentous keratitis, and corneal ulcers.

Depending on the symptoms of corneal inflammation, such types of keratitis are distinguished as:

• Non-purulent.
• Purulent.
• Catarrhal.

Depending on the localization of inflammation, keratitis can be:

• Superficial. In this case, only the corneal membrane, its epithelium or the anterior plate, which is also called Bowman's membrane, will be affected.
• Deep. This type of keratitis is also called stromal. In this case, the entire stroma of the cornea, its posterior membrane and internal endothelium are involved in the process of inflammation.

Depending on the nature of the course of inflammation, keratitis can be:

• Chronic.
• Subacute.
• Sharp.

Depending on the method of accumulation of inflammatory infiltrate, there are such types of keratitis as:

• Central keratitis. In this case, fluid accumulates at the pupil.
• Paracentral keratitis, when the exudate is localized opposite the iris.
• Peripheral keratitis, when an inflammatory fluid is concentrated near the limbus.

Keratitis symptoms

The more intense the inflammation of the cornea, the more intense the symptoms of keratitis. Also important is the pathogenic flora, which provoked the development of the disease.

The first symptoms of keratitis include:

• Redness of the eyes.
• Pain in the organs of vision.
• Lachrymation.

Regardless of the type of keratitis, a person will always have red eyes. However, sometimes the hyperemia is pronounced, and sometimes the redness is barely noticeable.

The main manifestations of the disease include:

• The cornea swells and becomes cloudy.
• The eyes lose their specularity.
• A person cannot look at the light, he intensifies the manifestation of the symptoms of the disease.
• Eyes hurt.
• Vision deteriorates.
• Blepharospasm develops, which manifests itself in involuntary twitching of the eye muscles.
• The vessels in the eyes swell, so the organs of vision will be permeated with capillaries that have increased in size.
• The cornea of the eye loses its former sensitivity.
• Infiltration appears on the cornea. Its color will depend on what the inflammatory exudate is. If it is purulent, then the color will be yellow, and if it contains mainly lymphoid cells, then the color of the infiltrate is grayish.
• When infiltration accumulates on the cornea, the patient will feel that there is a foreign object in his eye.

The infiltrate can have not only different colors, but also different locations and shapes. With significant inflammation, it occupies most of the eye. Sometimes erosion occurs at the site of the infiltration. It also tends to fall off the cornea.

Separate forms of keratitis

• Traumatic keratitis. They arise from damage to the cornea of the eye.
• Bacterial keratitis. If the bacteria were introduced into the cornea from the outside, then keratitis will develop as a creeping ulcer. In a patient, a defect is formed on the cornea, which has undermined edges. If a person does not receive treatment, the wound grows rapidly. When keratitis develops against the background of syphilis or tuberculosis, the corneal stroma suffers, with its deep vascularization. The overgrown vessels resemble brushes in appearance.
• Viral keratitis. The disease develops against the background of damage to the body with simple or herpes zoster. The cornea is covered with vesicles, or ramifications. If keratitis has a severe course, then the cornea becomes cloudy, large infiltrates are formed in it.
• Fungal keratitis. With this type of inflammation, the infiltrate will have a white color, it is loose, uneven, with ragged edges. Candida, aspergillus, and Fusarium fungi are capable of provoking mycotic keratitis.
• Allergic keratitis. Symptoms such as lacrimation, itching, redness of the eyes come to the fore. They appear after interaction with an allergen.
• Filamentous keratitis. Pathology develops with a lack of lacrimal fluid. The cornea of the eye becomes very dry, its cells die off.
• Acanthamebic keratitis. This type of inflammation is caused by amoebas that affect the lining of the eye.
• Creeping corneal ulcer. This type of keratitis is the result of a sharp foreign object entering the organs of vision. The disease is complicated by suppuration.
• Phlictenular keratitis. This disease is a companion for patients with tuberculosis. The inflammation will be concentrated in the place where the vessels of the cornea and sclera merge.
• Photokeratitis. The cornea suffers from damage from ultraviolet rays. This happens when working with a welding machine, or when spending a long time in the sun.
• Parenchymal keratitis. This keratitis occurs due to congenital syphilis. The disease can be transmitted through several generations. Persons under the age of 20 suffer from it. Both eyes are inflamed at once. The main symptom of the lesion is significant redness.
• Neutrophic keratitis. Inflammation can be provoked by a trauma to the ternary nerve, or an infection in the eye. In addition to inflammation, dystrophic changes in the organs of vision are observed.
• Rosacea keratitis. This disease manifests itself in older people who suffer from facial rosacea. To date, the causes of the development of the disease remain unclear.

Diagnosis of keratitis

To diagnose a doctor, a standard examination is often enough. The typical symptoms of keratitis can identify inflammation of the cornea.

The doctor collects anamnesis, clarifies with the patient what conditions preceded the development of the disease. It is important to clarify whether there was an injury or other damage to the organ of vision. The doctor then examines the patient.

The main diagnostic methods include:

• Visiometry. The doctor assesses the visual function using special tables.
• Fluorescent method. It makes it possible to understand whether the integrity of the cornea is violated.
• Analgesimetry allows you to check pain sensitivity.
• Ophthalmoscopy. During the study, the doctor assesses the condition of the eye and fundus, retina, blood vessels, optic nerve. The procedure is carried out on a special device - an ophthalmoscope.
• Biomicroscopy. The study is carried out using special equipment. The doctor examines the organ of vision using a slit lamp. It makes it possible to detect even small damage to the eyeball.
• Microscopy. During the procedure, a scraping is taken from a person. Its study allows you to determine the type of pathogenic flora that provoked inflammation.

If the eye was injured, or an infection was brought into it, then the inflammation is concentrated on one side. When a person develops a systemic disease, both eyes will be affected.

To clarify the nature of keratitis, a whole range of laboratory studies will be required. These include: conjunctival cytology, fluorescent antibody method. Among serological methods, the following are popular:

• RSK.
• Neutralization reaction.
• Nephelometry with various allergens (viral, bacterial, medicinal, tissue).

Also tests with tuberculin, herpes vaccine, brucellin and other antigens are carried out.

Keratitis treatment

After the reason for the development of keratitis is found out, the doctor prescribes treatment for the patient. In the absence of complications of the disease, therapy is carried out at home. If the organs of vision are significantly affected, then hospitalization is required.

The main areas of treatment for keratitis:

• Getting rid of the infection.
• Stimulates tissue repair.
• Elimination of symptoms of iridocyclitis.
• Absorbent therapy.

To cope with keratitis is most often possible with the help of conservative therapy.

Medical correction involves the implementation of the following methods:

• Relief from pain occurs with the use of local anesthetic drugs (Diftal).
• When keratitis develops due to the wearing of lenses, or due to their improper use, the patient is shown eye gels. They allow you to restore and moisturize the mucous membranes.
• Using moisturizing drops. They are used in case of malfunctions in the functioning of the eye glands.
• The use of antihistamines is indicated when inflammation is of an allergic nature. These medicines are used in the form of drops, injections, and tablets.
• Preparations for the destruction of bacteria: Tobrex, Levomycetin, Floxal, Tsipromed. If local treatment is not effective, then the tablets are prescribed orally, or antibiotics are injected.
• Preparations for the destruction of viruses: drops Oftalmoferon, Interferon, Zirgan, Zovirax, idoxuridine solution. They are used for herpes and adenovirus keratitis.
• With syphilitic lesions of the cornea, special antibiotics are used, as well as drugs for intramuscular administration. The patient will have to be observed not only by an ophthalmologist, but also by a venereologist.
• To dilate the pupil, mydriatics are used: Atropine, Tropicamide, Cyclomed. These drugs are needed in order to prevent the formation of adhesions between the iris and the pupil.
• Corticosteroids such as hydrocortisone or dexamethasone. These medications can help relieve puffiness and inflammation in the eyes.
• Preparations that accelerate the recovery processes in tissues: Korneregel, Actovegin.

When keratitis develops due to a foreign object entering the organs of vision, you need to get rid of it. Then the doctor assesses the degree of damage to the cornea and only then prescribes treatment.

To increase the effectiveness of therapy, the doctor directs the patient to undergo physiotherapy techniques. It can be phonophoresis, magnetotherapy, electrophoresis.

Surgery

The operation is indicated for patients who have an ulcerative defect on the cornea.

The intervention is carried out using modern equipment:

• Laser treatment, namely laser coagulation.
• Cold treatment, namely cryoapplication.
• Replacement of part of the cornea with a graft. This operation is performed when the damaged area of the eye has been replaced with scar tissue.

If the disease has a severe course and it was not possible to cope with the inflammation with all the listed methods, then the patient is shown removing the eyeball.

Complications

When it is possible to cope with keratitis, the patient may experience complications such as:

• Descemetocele.
• Corneal perforation.
• The appearance of a thorn.
• Glaucoma.
• Cataract.
• Sclerosis of the membranes of the eye.
• Limbit.
• Blindness.

Forecast and prevention

If the treatment was started on time, and the infiltration is small and is located on the surface of the cornea, then the prognosis is favorable. Such infiltrates most often dissolve completely, leaving behind cloudy opacities.

When keratitis is accompanied by damage to deep tissues, with the formation of ulcerative defects, the opacity will be more intense, vision suffers more. Worse prognosis with a central location of the infiltrate. Although competent keratoplasty can restore vision even to patients with leukemia.

An ophthalmologist should be consulted when the first vision problems appear. At the initial stage of the development of the disease, it is possible to cope with the use of eye drops. However, a doctor must prescribe them.

In order to prevent the occurrence of keratitis, it is necessary to avoid eye injuries, and promptly treat all diseases of the organs of vision.

Infectious keratitis is contagious. Therefore, you need to minimize contact with sick people, as well as monitor eye hygiene. When performing medical procedures, it is necessary to use gloves and individual instruments. All devices must be properly disinfected.

If a person uses contact lenses, then he should adhere to such recommendations as:

• Lenses need to be changed regularly.
• Lenses can only be washed with clean water.
• Store your lenses properly.
• The case should be changed at least once every 3 months.
• Lenses should be removed if they come into contact with water.
• To care for them, you need to use special products.
• Do not wet the lenses with saliva before putting them on.

Before putting the lenses, you should wash your hands well with soap and water.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".