What is keratitis and what forms are there?
The cornea consists of several layers and does not have blood vessels, so infection spreads quickly and defense mechanisms work more slowly. Inflammation can affect only the superficial epithelium, and then it heals without a trace, or penetrate into the deeper layers, leaving cloudiness. In severe cases, a corneal ulcer forms, which threatens to perforate the eye. Doctors classify keratitis based on the cause, depth, and location of the lesion. The choice of drugs depends on this, so there are no identical drops for all types of keratitis.
- Bacterial - often in lens wearers
- Viral - herpetic, adenoviral
- Fungal - after injury by plants
- Acanthamoeba - when lenses come into contact with water
- Non-infectious – dry eye, ultraviolet burn, trauma
- Superficial and deep, corneal ulcer
Causes and risk factors
Contact lenses disrupt the oxygen supply to the cornea and create conditions for germs, especially if you sleep in them, swim, rinse them with tap water, or wear them for longer than expected. The herpes simplex virus remains in the body after the first infection and can cause repeated keratitis due to stress, a cold or ultraviolet radiation. Microtraumas to the cornea from sand, metal shavings, nails, and branches open the way for infection. Welding and bright sun without protection cause corneal burns. Dry eyes, incomplete closure of the eyelids and decreased sensitivity of the cornea also contribute to inflammation.
- Sleeping and bathing with contact lenses
- Poor hygiene of lenses and containers
- Herpetic infection
- Injuries and foreign bodies
- Welding and UV without safety glasses
- Dry eye syndrome, incomplete closure of eyelids
- Self-administration of hormonal drops
Symptoms
Keratitis usually begins with a feeling of sand or debris in the eye, which quickly turns into pain. The eye becomes red, especially around the cornea, there is profuse lacrimation and severe photophobia, which makes it difficult to open the eye. Vision becomes blurred. A whitish spot may be noticeable on the cornea. With bacterial keratitis, there is a purulent discharge; with herpetic keratitis, the pain is sometimes weaker due to decreased sensitivity of the cornea. A welding burn manifests itself as sharp pain and lacrimation several hours after work.
- Pain and foreign body sensation
- Redness around the cornea
- Photophobia
- Tearing
- Blurred vision
- White spot on the cornea
- Spasm of the eyelids
Diagnostics
The ophthalmologist examines the eye at a slit lamp and instills fluorescein dye, which stains the damaged areas of the cornea. The shape and depth of the defect help suggest a cause: for example, a branching pattern is typical of herpes. If a bacterial, fungal or acanthamoeba infection is suspected, a scraping is taken from the cornea for microscopy and culture to determine sensitivity to drugs, and sometimes contact lenses and the container are examined. PCR is used to diagnose viral keratitis. The doctor also checks the sensitivity of the cornea and measures intraocular pressure.
- Slit lamp biomicroscopy
- Fluorescein staining
- Corneal scraping for microscopy and culture
- Culture from contact lenses and container
- PCR for herpes viruses
- Confocal microscopy of the cornea according to indications
Treatment and prevention
Treatment is prescribed only by an ophthalmologist, depending on the pathogen. For bacterial keratitis, frequent instillation of antibacterial drops is used, for herpes - antiviral drugs, for fungal and acanthamoeba - special long courses. Contact lenses are completely discontinued during treatment. Hormonal drops without a doctor's prescription are dangerous: in case of herpes and fungal infections, they can lead to perforation of the cornea. In case of deep scars and the threat of perforation, a corneal transplant is performed. For prevention, it is important to follow the rules of wearing lenses and protect your eyes when working.
- Avoiding contact lenses until recovery
- Antibacterial, antiviral or antifungal drops as prescribed
- Removal of corneal foreign body
- Moisturizing drops and light protection
- Keratoplasty for scars and perforation
- Don't sleep or swim with your lenses on
- Safety glasses for welding and working with metal
