interstitial keratitis

1. INTERSTITIAL
KERATITIS
BALAJI S

2. 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.

3. Causes
 Congenital syphilis
 TB
 Cogan’s syndrome
 Acquired syphilis
 Trypanosomiasis
 Leprosy
 Malaria

4. Syphilitic interstitial
keratitis
CONGENITAL ACQUIRED
More common 90% Less common
Bilateral Unilateral
Age - (5 – 15 ) yrs Any age

5. Pathogenesis
T.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

6. symptoms
• Pain
• Lacrimation
• Photophobia
• Blurring of vision
• Blepharospasm

7. Clinical features
 Hutchinson’s triad – congenital syphilis
Interstitial
keratitis
Hutchinson’s
teeth
Vestibular
deafness

9. Stages
 Initial progressive stage
 Florid stage
 Stage of regression

11. 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

14. 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.

16. 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.

18. Diagnosis
Corneal haze & other typical findings on
slit lamp examination.
Serology
- VDRL
- T.pallidum immobilisation test
- micro haemagglutination assay
- fluorescent Ab absorption test

19. 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

20. SYSTEMIC
- high doses of penicillin to
prevent further development of lesions
- systemic steroids can be given in
refractory cases.

21. 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

22. 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.

24. Treatment
• Urgent evaluation is indicated because
early treatment prevents permanent
deafness & blindness.
• Systemic & topical corticosteroids.

25. Thank You