Keratitis is an inflammatory disease that is localized in the cornea of the eye. This disease is characterized by unpleasant symptoms, but thanks to the achievements of modern medicine, it is highly treatable; the main thing is to seek qualified medical help in time.
The cornea is the most important part of the so-called optical system of the eye, responsible for visual effects. The cornea is the front transparent layer of the eye. The clarity of vision and its acuity largely depend on the condition of the cornea. There is a set of parameters of the cornea that ophthalmologists measure: surface curvature, structure, transparency, sphericity and others. Due to the inflammation that occurs with keratitis, changes may occur in the cornea. These changes cannot always be corrected by treatment - they can be irreversible. Therefore, it is important to consult a doctor in time and start therapy as early as possible so as not to worsen the problem.
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General information
The cornea is a relatively dense, transparent layer that protects the front, exposed surface of the eyeball. Both the shape of the cornea (it should be as flat, smooth, spherical as possible) and its transparency are of key importance, since any optical interference - turbidity, inhomogeneous inclusions, scars, etc. - distorts the normal refraction of light and/or reduces its intensity on the way to the retina inevitably affects the quality of the final visual image. Unlike some other inflammatory processes of the eye (blepharitis, conjunctivitis), which may not significantly affect visual acuity, with keratitis there is almost always a decrease in visual function. That is why it is extremely important to begin treatment as soon as possible, before irreversible scar changes form on the main optical axis of the eye.
What kind of disease is keratitis?
The cornea is the anterior avascular layer of the eye. Normally, it is a transparent, spherical, shiny and smooth tissue with high sensitivity. The cornea performs not only protective functions; it is the main refractive medium of the optical system of the eye. That is why her condition largely determines the sharpness and clarity of vision.
Eye keratitis is an inflammatory lesion of the cornea. Depending on the type of disease, it can be the result of a viral or bacterial infection, injury, allergic reaction, etc. The most common causes of inflammatory keratitis are the following:
- Damage to the eyes that leads to disruption of the integrity of the cornea (post-traumatic keratitis).
- Bacterial and fungal infections of the eyes. Because of them, ulcers or purulent infiltrates form on the surface of the cornea. The causative agents are strepto-, staphylo-, pneumococci, Escherichia coli, chlamydia and other bacteria. Among pathogenic fungi, the disease is most often provoked by aspergillus and candida.
- Conjunctivitis and its complications. The conjunctival cavity contains microflora, which, if the cornea is damaged, can cause an inflammatory process. If you touch your eyes with your hands during illness, there is a high risk of causing keratitis.
- Viral damage. The most popular causative agent of keratitis is herpes (60-70% of cases). It can also be caused by adenovirus, measles, smallpox and other viruses.
- Allergy.
- Ultraviolet radiation (photokeratitis).
- Vitamin deficiency (in particular, lack of vitamin A).
- Individual sensitivity to contact lenses or improper use of them.
- Some diseases (arthritis, Sjogren's disease, etc.).
This is what keratitis looks like in the photo.
Based on how deep the pathological process has penetrated into the tissue, superficial and deep keratitis are distinguished. The superficial one goes deep into no more than 1/3 of the cornea. Such keratitis responds well to treatment with drops and other methods, passes without consequences or leaves slight clouding of the cornea. Deep keratitis affects the entire cornea, requires complex therapy and can leave scarring that negatively affects vision.
Based on location, the lesion is divided into:
- central keratitis - damage to the cornea in the pupil area;
- paracentral keratitis - localized in the iris area;
- peripheral keratitis - affects areas outside the iris and pupils.
Types and types of keratitis
In publications you can often find a division of keratitis into exogenous (caused by external influences) and endogenous (caused by internal factors present in the body). However, such a classification seems too general and not entirely successful; It is unclear, for example, to which class allergic keratitis associated with wearing contact lenses should be classified: on the one hand, the allergic reaction is caused by internal immune disorders, on the other, by an external, artificial object.
According to the dynamics of development and type of course, acute and chronic keratitis are distinguished; as a variant of the second type, recurrent keratitis is sometimes considered separately.
The depth of spread of the inflammatory process is essential: superficial keratitis is much less dangerous than deep keratitis, in which the inner corneal layers are scarred.
According to the degree of severity, keratitis is usually divided into mild, moderate and severe; according to the localization of inflammation - central and peripheral.
However, the most convenient and intuitive is the etiological classification, where keratitis is grouped according to the direct causes of the inflammatory process.
Causes of the disease
The main factors of corneal inflammation include:
- eye injuries, incl. chemical, physical, mechanical damage (foreign body, ultraviolet burn from the blinding light of an electric welding arc, intense solar radiation, etc.);
- infections (viral, bacterial, fungal);
- allergic reactions, incl. severe seasonal, drug, onchocerciasis allergies.
Actually, onchocerciasis keratitis, although it is more often classified as allergic, is essentially parasitic, since the allergenic toxin is produced by helminths from the filaria family. Similarly, the very common infectious-allergic keratitis when wearing contact lenses is most often caused not by the lenses as such, but by non-compliance with the rules of hygiene and care for them, as a result of which the cornea becomes infected.
More rare forms are neurogenic keratitis, keratitis due to hypo- or vitamin deficiency, as well as idiopathic keratitis (for example, the so-called filamentous), the causes of which have not yet been reliably established.
Symptoms and signs
Almost all types and types of keratitis are characterized by the so-called. corneal syndrome, including increased lacrimation, increased sensitivity to light and uncontrolled closure of the eyelids (blepharospasm). As a rule, redness is pronounced, the vascular network becomes noticeable, and in severe cases, neovascularization (vascular neoplasms) occurs. The pain can be quite intense. The corneal layer swells, the surface loses its smoothness and often ulcerates (sometimes with a tendency to peel off), and infiltrates appear. Cloudiness of the cornea becomes one of the main symptoms and complaints with keratitis, since the opacity or translucency of the cornea has an extremely negative effect on the acuity and clarity of vision.
Keratitis is often accompanied by concomitant symptoms, the severity of which varies from mild to moderate discomfort (dry nasal and oral mucosa, headache, difficulty swallowing) to severe complications from the periodontium, gastrointestinal tract, etc. Various types of keratitis are characterized by their own specific features.
Clinical picture
The clinical picture of keratitis is a series of manifestations specific to this disease, which have received a special name - corneal syndrome.
It includes symptoms:
- increased lacrimation;
- photophobia;
- narrowing of the palpebral fissure, it is impossible to open the eye completely;
- eye pain;
- sensation of a foreign object in the eye;
- redness of the eye.
In severe cases, the inflammatory process spreads to other parts of the eye and affects the sclera and iris. Another possible complication is ulceration at the site of inflammation. It can lead to perforation, in which infection enters the deep structures of the eye.
Viral keratitis
Keratitis caused by viruses is often accompanied by a blistering rash. The pathogenic agent can be almost any aggressive virus (measles, chickenpox, adenoviruses), but most often it is the herpes virus. As is known, over 95% of the population is infected with herpes infection, and in most cases, herpes occurs latently, in an asymptomatic form, and is activated only when immune resources are weakened, general exhaustion of the body and other unfavorable conditions. In this case, inflammation of the cornea is usually preceded by typical herpetic symptoms - rashes on the lips or other mucous membranes. With herpetic keratitis, as a rule, swelling and the appearance of fuzzy, vague infiltrates predominate.
Treatment of keratitis in adult patients
Treatment of the disease can be either conservative or surgical. The doctor determines how to treat keratitis. He may prescribe antibiotics, antihistamines, and antiviral drugs for oral administration. Locally - antibacterial, antiseptic, moisturizing drops, anti-inflammatory ointments and gels, agents that defeat the herpes virus. In addition, the specialist will select medications that promote regeneration.
If the process has gone too far, surgery may be indicated, which may involve excision of the affected area of the cornea, replacing it with a graft, and removing superficial scars and scars.
Prevention of keratitis of any etiology consists of maintaining immunity, timely treatment of general and eye diseases, eye hygiene and timely examinations by an ophthalmologist.
Bacterial keratitis
Keratitis can be caused by a variety of pathogenic microorganisms, primarily cocci (Staphylococcus aureus, Streptococcus, Gonococcus) and Pseudomonas aeruginosa. A rare and very dangerous infection, even resulting in blindness, is acanthamoeba infection (named after the causative agent Acanthamoeba), which can exist, in particular, in the gap between the contact lens and the surface of the cornea. With the development of the so-called creeping corneal ulcers caused by gonococcal, tuberculosis, syphilitic and other bacterial infections, the risk of rapid and irreversible loss of vision is also very high.
Diagnostics
Diagnosis of herpetic keratitis begins with examination. The presence of characteristic blisters suggests a lesion caused by herpes. Since the disease can be sluggish, without characteristic manifestations, the diagnosis is clarified using laboratory and instrumental studies. To detect the pathogen, scrapings are taken from the affected tissues or tear fluid.
Laboratory diagnosis of ophthalmoherpes includes:
- Study of scrapings from the conjunctiva using fluorescent antibodies.
- Linked immunosorbent assay.
- Blood or tear fluid test for antiherpetic antibodies.
- Polymerase chain reaction (PCR) of biological fluids that detects the virus.
Instrumental examination helps to assess the extent and depth of anatomical changes. Instrumental diagnostics include anterior optical coherence tomography, biomicroscopy and fluorescein test.
A fluorescein test is performed to identify ulcers or films on the cornea and assess the area and extent of the lesion. After applying the solution to the eye, the ophthalmologist examines the tissue using a slit lamp with a blue filter.
Treatment of the disease
Almost all special sources emphasize the dangers of self-diagnosis and self-medication. The fact is that it is almost impossible for a non-specialist to distinguish incipient keratitis from “ordinary” conjunctivitis, and the bacterial form, for example, from a fungal one. Meanwhile, therapy in each case should be aimed at eliminating the primary pathogenic factor.
Thus, viral infections require stimulation of the immune response with interferon preparations (or medications that promote its production in the body) or antiviral agents. These include: Oftalmoferon, Poludan, Acyclovir, etc.
For bacterial infections, treatment with antibiotics is necessary, and their choice, dosage, and duration of treatment should correspond as closely as possible to the type and sensitivity of the pathogen. Typically, ophthalmologists prescribe medications in the form of Vitabact, Levomycetin, Tsipromed eye drops or ointments (Tetracycline, Floxal, Tobrex, Erythromycin eye ointment).
Fungal infections of the cornea usually require much longer treatment compared to other forms, and include specific antimycotic drugs based on fluconazole, natamycin, amphotericin, etc.
The main method of relieving allergic reactions are drugs that suppress the secretion of histamine and reduce the reactivity of H1 receptors. The most well-known and widely used antiallergic drug since the mid-90s remains loratadine (and numerous generic medications based on it). Basic antiallergic drops: Opatanol, Lecrolin, Allergodil.
As additional therapy aimed at relieving general inflammatory symptoms, vasoconstrictors, moisturizers, hormonal and non-steroidal anti-inflammatory drugs can be prescribed. Physiotherapeutic methods (laser irradiation of the cornea, electrophoresis of drugs) are actively used.
However, the main factors of therapeutic success in the treatment of keratitis, which allow preserving vision and preventing chronification of the process, the development of severe complications, and involvement of the deep layers of the cornea, are:
- timely seeking help, refusal to attempt self-medication;
- reliable differential diagnosis in order to establish the causes of inflammation, the type of pathogen, the severity and localization of the process;
- adequate etiopathogenetic therapy aimed at eliminating the pathogenic factor.
By contacting our ophthalmology center, you are guaranteed to receive high-quality diagnostics and effective treatment of diseases by recognized specialists using high-tech equipment! Remember: keratitis is a serious disease that can lead to the most severe consequences, including permanent loss of vision.
How is eye keratitis treated?
Keratitis is a disease with serious consequences, so treatment is often carried out in a hospital. When selecting appropriate therapy, three factors are taken into account: the cause of the disease, the severity of symptoms and the depth of damage to the cornea. Medications - primarily drops for keratitis for adult patients - are used to treat viral and bacterial types of the disease. Antiseptics are also used for epithelization on the cornea of the eye.
If deep ulcers, scars, or glaucoma form on the cornea, then surgical treatment for keratitis is necessary. Laser and microdiathermocoagulation, sclerectomy, trepanation of the sclera and other operations are used.
Here is a table that will help you choose the right eye drops and ointments for keratitis in adults.
| Type of keratitis | Drugs for treatment |
| Bacterial | Antibiotics are prescribed (Ofloxacin, Dancil, Oftaquix, Oflomelid, Levofloxacin). They are instilled in the form of drops, laid in the form of ointments. In case of serious damage to the cornea due to keratitis, injections are prescribed into the tissue around the eyeball or into the conjunctiva of the eye. |
| Viral | Antiviral drugs are used. The most popular are Florenal, Pimafucort, Zovirax, Lokoid, Acyclovir. |
| Fungal _ | Antifungal agents are prescribed - Pimafucin, Ampholip, Amphotericin B. |
| Allergic | Doctors prescribe antihistamines. Opatanol, Vizalergol, Allergodil are instilled into the eyes. Claritin, Citrine, Loratadine, Zodak, etc. are prescribed orally. |
| Traumatic | For traumatic keratitis, restorative drops and ointments are used to quickly restore the cornea, for example, Korneregel and Taurine. |
With mild keratitis and timely treatment, the infiltrates are located on the surface, so it is possible to completely restore the transparency of the cornea. In severe cases, vision may deteriorate. In any case, ophthalmologists recommend consulting a doctor at the first feeling of discomfort or pain in the eyes in order to prevent the development of dangerous diseases.
