Keratitis Health Article

Causes and symptoms

In summary, keratitis can be caused by:

• bacterial, viral, or fungal infections
• dry eyes resulting from disorders of the eyelid or diminished ability to form tears
• exposure to very bright light
• foreign objects that injure or become lodged in the eye
• sensitivity or allergic reactions to eye makeup, dust, pollen, pollution, or other irritants
• vitamin A deficiency, which people with normal diets rarely develop

Symptoms of keratitis include, but are not limited to:

• tearing
• pain
• sensitivity to light

• inflammation of the eyelid
• decrease in vision
• redness

Diagnosis

A case history will be taken and the vision will be tested. Examination with a slit lamp, an instrument that's a microscope and focuses a beam of light on the eye, is important for diagnosis. The cornea can be examined with fluorescein, a yellow dye which will highlight defects in the cornea. Deeper layers of the cornea can also be examined with the slit lamp. Infiltrates, hazy looking areas in the cornea, can be seen by the doctor and will aid in the diagnosis. Samples of infectious matter removed from the eye will be sent for laboratory analysis.

Treatment

Antibiotics, antifungals, and antiviral medication will be used to treat the appropriate organism. Broad spectrum antibiotics will be used immediately, but once the lab analysis determines the offending organism the medication may be changed. Sometimes more than one medication is necessary. It depends upon the infection, but the patient should be clear on how often and how to use the medications.

A sterile, cotton-tipped applicator may be used to gently remove infected tissue and allow the eye to heal more rapidly. Laser surgery is sometimes performed to destroy unhealthy cells, and some severe infections require corneal transplants.

Antifungal, antibiotic, or antiviral eyedrops or ointments are usually prescribed to cure keratitis, but they should be used only by patients under a doctor's care. Inappropriate prescriptions or over-the-counter preparations can make symptoms more severe and cause tissue deterioration. Topical corticosteroids can cause great harm to the cornea in patients with herpes simplex keratitis.

A patient with keratitis may wear a patch to protect the healing eye from bright light, foreign objects, the lid rubbing against the cornea, and other irritants. Sometimes a patch can make it worse, so again, the patient must discuss with the doctor whether or not a patch is necessary. The patient will probably return every day to the eye doctor to check on the progress.

Although early detection and treatment can cure most forms of keratitis, the infection can cause:

• glaucoma
• permanent scarring
• ulceration of the cornea
• blindness

Prevention

Children and adults who wear contact lenses should always use sterile lens-cleaning and disinfecting solutions. Tap water is not sterile and should not be used to clean contact lenses. It is important to go for follow-up checkups because small defects in the cornea can occur without the patient being aware of it. Do not overwear contact lenses. Remove them if the eyes become red or irritated. Replace contact lenses when scheduled to do so. Proteins and other matter can deposit on the contacts, leading to an increased risk of infection. Rinse contact lens cases in hot water every night, if possible, and let them air dry. Replace contact lens cases every three months. Organisms have been cultured from contact lens cases.

Eating a well-balanced diet and wearing protective glasses when working or playing in potentially dangerous situations can reduce anyone's risk of developing keratitis. Protective goggles can even be worn mowing the lawn so that if twigs are tossed up they can't hurt the eye. Goggles or sunglasses with UV coatings can help protect against damage from UV light.

BOOKS

Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.

ORGANIZATIONS

American Academy of Ophthalmology. 655 Beach Street, P.O. Box 7424, San Francisco, CA 94120-7424. <http://www.eyenet.org>.

American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. <http://www.aoanet.org>.

National Eye Institute. 2020 Vision Place, Bethesda, MD 20892-3655. (301) 496-5248. <http://www.nei.nih.gov>.

Prevent Blindness America. 500 East Remington Road, Schaumburg, IL 60173. (800) 331-2020. <http://www.preventblindness.org>.

OTHER

"Infection-causing Organism Dictates Microbial Keratitis Treatment." Slack Inc. Page. 21 May 1998 <http://www.slackinc.com/areas.asp>.

"Keratitis." ThriveOnline. 20 May 1998 <http://thriveonline.oxygen.com>.

"Ohthalmologic Disorders." The Merck Page. 21 May 1998 <http://www.merck.com>.

"To Avoid Infection, Make RGP Patients Aware of Tap Water Risk." Slack Inc. Page. 21 May 1998 <http://www.slackinc.com/eye/pcon/199603/taph20.htm>.

Maureen Haggerty