Topic 28
=Stromal aka deep keratitis → inflammation corneal stroma with or without involving posterior corneal layer
- Non-suppurative (non pus forming ) → interstitial keratitis , disciform keratitis, keratitis profunda and sclerosing keratitis
- Suppurative central corneal abscess and posterior corneal abscess
Interstitial Keratitis
- =inflam. of corneal stromal without primary involvement of epithelium or endothelium
- Causes= Congenital syphilis , TB, Cogan’s syndrome, Acquired syphilis, Malaria, leprosy, sarcoidosis & trypanosomiasis
- Syphilitic interstitial → associated with 90 with congenital
- Pathogenesis → Local antigen-antibody reaction Invasions of cornea &sensitises it during general diffusion in foetal stage Later a small-scale fresh invasion of Treponema pallidum and excites the inflammation of the previously sensitised cornea; triggered by an injury or OP
- Clinical: responsible for late complication of congenital syphilis
- Several stages : Initial , Florid , regression
- → Initial → oedema of endothelium& deeper stroma (presence of keratin precipitates) Pain +lacrimation+photophobia+blepharospasm
- → Florid → remains acutely inflammation , Deep vascularisation of cornea & salmon patch appearance =vessels covered by oedema hazy cornea= dull reddish pink
- → Regression→resolving of acute inflammation, very slow 1-2 years , ghost cells form as lesions resolve and leave opacities
- Diagnosis → Positive VDRL or Treponema pallidum
- Treatment: of keratitis + systemic treatment of syphilis Corticosteroid drops (dexamethasone 0.1% drops 2-3hours and as it is allergic steroid Work well against it) Atropine, goggles→ photophobia, keratoplasty if opacities remain Penicillin in high doses
Tuberculosis interstitial keratitis Similar to syphilis but usually unilateral and affect a lower secotion of cornea Treated with antitubercular drugs+topical steroids