Keratitis
This is inflammation of the cornea.
They often accompany or are accompanied by conjunctivitis, in which case we speak of keratoconjunctivitis.
The origin of keratitis is very diverse: infectious (bacterial, viral, mycotic), allergic, post-traumatic, etc.
Symptoms:
Eye pain and redness, decreased vision, discomfort in light (photophobia) and a foreign body sensation.
The interview:
First, we will eliminate traumatic or exposure keratitis: projection of a foreign body, ash, caustic chemicals, as well as the improper wearing of contact lenses.
Then the diagnostic search will focus on bacterial or viral causes or an allergic background.
Examination:
Keratitis will be highlighted by a fluorescein test: the doctor will put a colored eye drop that will attach to the keratitis lesion and give its shape and extent.
It can be fine, punctate, very superficial, or deeper, nodular.
It is often associated with conjunctivitis.
Finally, a decrease in visual acuity, inconstant, can be objectified, it depends on the severity of the keratitis.
Evolution:
The main consequences of keratitis are:
– corneal ulcer with rare and extreme progression towards perforation of the cornea with purulent melting of the eye,
– definitive loss of regularity of the corneal surface, more or less localized, which distorts vision.
Some special forms:
Exposure keratitis:
It occurs when the eye is poorly protected by the eyelids, either because they are deformed or poorly positioned. The most common causes are external projections, ectropion or chalazion and paralysis of the VII nerve (Bell's palsy, facial paralysis a frigore).
It first presents with a superficial punctate lesion or as a more significant abrasion, depending on the nature of the causative agent. Treated early, there are no consequences. Over time, epithelial erosion is possible. Superinfection can then occur and lead to scarring or loss of the eye.
Lubrication of the eye is very important. Artificial tears in the form of eye drops or gel will be prescribed. When the eyelid abnormality is permanent, surgical correction should be considered. When it is temporary, as in Bell's palsy, lubrication and/or an eye patch on the eyelids are effective.
If these prove insufficient, temporary tarsorrhaphy (closure of the eyelids with a stitch) is very useful.
Bacterial keratitis:
Bacterial keratitis is most often associated with minor trauma to the cornea or the wearing of contact lenses. The risk of corneal ulcers is even higher if contact lenses are worn for a very long time, during sleep or poorly maintained.
On examination, there is a focal or diffuse whitish opacity with adjacent edema. There is of course ciliary congestion and uveitis with or without hypopyon, depending on the severity of the infection.
Pseudomonas and Staphylococcus aureus are the most common germs involved in contact lens wearers. Other common organisms such as streptococci, pneumococcus and gonococcus are sometimes found.
Bacterial keratitis is very serious: it can lead to ocular perforation if caused by a virulent germ. In addition, it can leave a debilitating corneal scar.
An urgent consultation in Ophthalmology is therefore indicated. Samples for culture will be taken and treatment with antibiotics will be started.
Herpetic keratitis:
The herpes virus can cause many types of eye problems: blepharitis, conjunctivitis, keratitis, and uveitis. As in the mouth, it tends to recur, often with serious consequences.
Keratitis can present different forms: sometimes superficial punctate keratitis. However, it will be most easily recognizable when it presents in the form of a dendrite: a small ulcerated lesion with many ramifications and resembling a tree.
It can also attack the deeper layers of the cornea and cause edema with or without necrosis. These inflammatory stromal lesions can leave scars and lead to permanent loss of vision.
Herpetic keratitis must therefore be considered a very serious infection requiring urgent ophthalmological care.
Cortisone eye drops should be avoided. Antiviral treatment in the form of eye drops or ointment will then be undertaken.
Another viral keratitis: adenovirus keratitis:
Always associated with conjunctivitis, it first presents itself as fine superficial punctuations capturing fluorescein. Over time, these punctuations become deeper and form subepithelial opacities. This causes a variable loss of vision and photophobia.
If there is a loss of vision, an ophthalmology consultation is recommended.
