Interstitial Keratitis

Interstitial Keratitis

 

FACE AND FACIAL SYMMETRY       

Saddle-nose, deafness, and underdeveloped dentition – congenital syphilis.

 

CORNEA

Mid-stromal corneal opacity involving the visual axis

Ghost vessels within the lesion.

+/- Thinning of cornea

Mutton fat KPs (TB, Syphilis, Leprosy, Sarcoid)

Lipid keratopathy +/-

Also check,

Sensation

Pachymetry

ANTERIOR CHAMBER

Activity

IRIS AND PUPIL

Pupil function examination may be abnormal due to optic nerve and retinal disease.

LENS

Opacity

POSTERIOR SEGMENT

Optic Atrophy, Salt, and pepper retinopathy – syphilis

IOP

FELLOW EYE

If bilateral condition – congenital syphilis

SYSTEMIC CONDITIONS

Deafness, tinnitus, Vertigo – Cogan's syndrome

Saddle-nose, deafness, and underdeveloped dentition - Congenital Syphilis

Ocular & Systemic signs of Lyme disease, leprosy, brucellosis, leptospirosis, Herpetic eye disease, onchocerciasis, acanthamoeba, Cogan syndrome, RA, Wegener's, PAN

Questions:

What systemic Investigations will you advise?

Systemic Investigations

CBC, ESR

CXR

Mantoux Test

VDRL, FTA

Connective tissue Screen (PAN)

How does luetic (syphilitic) keratitis present?

It usually develops in the first or second decades of life. It can be divided into three stages:

The Early stage is characterized by ocular pain, photophobia, and peripheral sectorial corneal involvement. Keratic precipitates are often seen

The florid stage is when the inflammation is at its peak with iridocyclitis. There are deep stromal vessels that may give a pink color to the cornea (salmon pink).

The regression stage is characterized by vascular regression and clearing of the stromal infiltrates, leaving scarring.

Before the availability of steroids, clearing could take up to 1 or 2 years.

Purely stromal involvement, with sparing of epithelium and endothelium

What is the Etiology of interstitial keratitis?

 Interstitial keratitis is either infectious or immune-related.

The most common etiologies of interstitial keratitis in the United States are Herpes Simplex Virus and Syphilis.

Bacterial etiologies: Syphilis, Lyme Disease, Tuberculosis, Leprosy, Brucellosis, Leptospirosis

Viral etiologies: Herpesviridae (Herpes simplex, Herpes Zoster, Epstein-Barr), HLTV-1, Mumps, Measles, Vaccinia, Variola

Parasitic etiologies: Onchocerciasis, Acanthamoeba, Leishmaniasis, Trypanosomiasis, Microsporidiosis

Immune etiologies: Cogan syndrome, sarcoidosis, mycosis fungoides, contact lens-associated keratitis, intracorneal foreign body, heavy metals, autoimmune disease, e.g., rheumatoid arthritis, granulomatosis with polyangiitis (formerly known Wegener's)

Interstitial keratitis has a low overall incidence, accounting for only 3% of all keratoplasties conducted in the United States. Herpetic and syphilitic diseases collectively contribute to over 50% of interstitial keratitis cases in the United States.

What is Cogan Syndrome?

Cogan's syndrome, also known as Cogan syndrome, is a rare condition predominantly observed in young adults, which can significantly impact both vision and hearing. Dr. David G. Cogan, from the Massachusetts Eye and Ear Infirmary, initially described this syndrome in 1945 as a combination of nonsyphilitic interstitial keratitis and vestibulo-auditory symptoms. Since then, only a few hundred cases have been documented in medical literature. Cogan syndrome is distinguished by recurrent inflammation in the eyes and hearing loss, which, if not addressed, may progress to deafness.