KERATITIS
TAKDIR TAHIR
MEDICAL SURGICAL NURSING
DEPARTEMENT
HASANUDDIN OF UINIVERSITY
Definition
Keratitis is an inflammation of the cornea,
the transparent membrane that covers the
colored part of the eye (iris) and pupil of
the eye.
Risk factors that increase the
likelihood of developing this
condition include:
Poor contact lens care; overuse of contact lenses
Illnesses or other factors that reduces the body's
ability to overcome infection
Cold sores, genital herpes, and other viral
infections
Crowded, dirty living conditions; poor hygiene
Poor nutrition (especially a deficiency of
Vitamin A, which is essential for normal vision).
Herpes simplex keratitis
A major cause :
Chronic inflammation of the cornea
Development of tiny blood vessels in the
eye
Scarring
Loss of vision
Glaucoma.
Pathophysiology :
HSV infection in mucocutaneus distribution of trigeminal nerve
Virus spreads (infected ephitelial cells to nerby sensory nerve ending)
Transported along nerve axon to cells body located in trigeminal
ganglion
Virus genome enters the nucleus of neuron
Infection of nerve cell in trigeminal ganglion
Interneural spread of HSV in ganglion
Develop ocular disease
Bacterial keratitis
People who have bacterial keratitis wake up with their
eyelids stuck together. There can be pain, sensitivity to
light, redness, tearing, and a decrease in vision. This
condition, which is usually aggressive, can be caused by
wearing soft contact lenses overnight. One study found
that overnight wear can increase risk by 10-15 times
more than if wearing daily wear contact lenses.
Improper lens care is also a factor. Contaminated
makeup can also contain bacteria.
Bacterial keratitis makes the cornea cloudy. It may also
cause abscesses to develop in the stroma, which is
located beneath the outer layer of the cornea.
Pathophysiology :
Interruption of an intact corneal epithelium and/or abnormal tear
film
permits entrance of microorganisms into the corneal stroma
proliferate and cause ulceration
Acute inflammatory cells (mainly neutrophils) surround the
beginning ulcer
cause necrosis of the stromal lamellae
Diffusion of inflammatory products (including cytokines)
posteriorly elicits an outpouring of inflammatory cells into the
anterior chamber
create a hypopyon
Fungal keratitis
Usually a consequence of injuring the
cornea in a farm-like setting or in a place
where plant material is present, fungal
keratitis often develops slowly. This
condition:
Usually affects people with weakened immune
systems
Often results in infection within the eyeball
May cause stromal abscesses.
Pathophysiology :
trauma (eg, contact lens wear, foreign material,
prior corneal surgery)
a defect in the epithelium
Fungi access into the corneal stroma
multiply and cause tissue necrosis (with
Mycotoxins and proteolytic enzymes)
an inflammatory reaction
Interstitial keratitis
Also called parenchymatous keratitis, interstitial
keratitis is a chronic inflammation of tissue deep
within the cornea.
Interstitial keratitis affects both eyes and usually
occurs as a complication of congenital or
acquired syphilis. In congenital syphilis it can
occur between age two and puberty.
It may also occur in people with tuberculosis,
leprosy, or other diseases.
Causes
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
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
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.
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 patient's with herpes simplex keratitis.
Complications
Although early detection and treatment can
cure most forms of keratitis, the infection
can cause:
Glaucoma
Permanent scarring
Ulceration of the cornea
Blindness.
Thanks for your attention
For further information, access:
www.healthatoz.com/healthatoz/Atoz/ency/keratitis.jsp
www.emedicine.com/oph/topic261.htm
www.revoptom.com/handbook/sect3a.htm
