| Interstitial keratitis | |
|---|---|
| Specialty | Ophthalmology |
Interstitial keratitis (IK), also known asImmune Stromal Keratitis (ISK), is aneye disorder characterized byscarring of thecornea due to chronicinflammation of thecorneal stroma (keratitis). "Interstitial" refers to space betweencells (i.e. the corneal stroma, which lies between theepithelium and theendothelium).
Acutely, early symptoms include a painful,photophobic, red watery eye. This is due to active corneal inflammation resulting in vascular invasion and stromalnecrosis which can be diffuse or localized. This causes the pinkish discoloration of what was a clear transparent normal corneal tissue (calledSalmon patch of Hutchinson).[citation needed]
Such vascularization is likely to result in blurring of vision secondary to corneal stromal scarring, the presence of ghost vessels, and thinning of the cornea, especially if it involves thevisual axis.[citation needed]
By far the most common cause of IK issyphilitic disease. However, there are two possible causes of the corneal inflammatory response: an infection and/or an immunological response, such as ahypersensitivity type reaction, or (rarely) Cogan syndrome.[1] Infectious causes include syphilis (commonest), followed by other bacterial infections (TB,Leprosy andLyme disease) and parasitic infections (Acanthamoeba,Onchocerciasis orriver blindness,Leishmaniasis,Trypanosoma cruzi orChagas disease,Trypanosoma brucei orAfrican sleeping sickness and microsporidia)[2]
The corneal scarring is the result of the initial invasion ofblood vessels into the corneal stroma as part of the inflammatory response. Since normal corneal tissue should be avascular (no blood vessel) and therefore clear to allow light to pass, the presence of blood vessel and the infiltration of cells as part of the inflammatory process results in scarring or hazing of the cornea.[3]
A positive VDRL of Treponema pallidum immobilization test confirms diagnosis of luetic(syphilitic) interstitial keratitis[citation needed]
The underlying cause must be treated as soon as possible to stop the disease process.Corticosteroid drop can be used to minimize the scarring on the cornea along withantibiotic cover. However, residual scarring cannot be avoided which can result in long term visual impairment and corneal transplantation is not suitable due to high rejection rate from the corneal vascularization.[4]
Previous long-standing eye infection which possibly during childhood time recalled as being treated with antibiotic and/or hospitalized over long period of time.[citation needed]