Keratitis – How to Recognize and Manage it Correctly

Keratitis of the eye is an inflammation of the cornea caused by various factors, representing one of the main causes of infectious blindness globally. This condition is serious, often requiring prompt medical intervention to prevent various severe complications.

In this article, we will explore the causes and types of keratitis, the main symptoms, as well as diagnostic methods. At the same time, we will present a detailed care plan, including available treatments and preventive measures. Our goal is to provide patients and caregivers with essential information for the correct management of keratitis and for maintaining eye health.

Keratitis – what is this condition?

The cornea is the transparent anterior layer of the eye, having a convex shape and a central position in ocular anatomy. Its main role is to allow light to enter the eye and to help focus it on the retina. It also acts as a protective barrier against external agents (such as dust, bacteria, and chemicals), playing an essential role in protecting the eyeball.

The structure of the cornea is complex and consists of several layers with well-defined roles:

• Epithelium – the outer layer that acts as a protective shield and aids in corneal regeneration in case of minor injuries;
• Bowman’s membrane – a thin layer of collagen that strengthens the corneal structure and protects the deeper layers;
• Stroma – the central, thickest layer, composed of collagen fibers and water, which gives the cornea transparency and resistance;
• Descemet’s membrane – a fine layer that acts as a supporting membrane for the endothelium;
• Endothelium – the inner layer of the cornea, responsible for maintaining fluid balance in the cornea and preventing edema.

Each layer has a specific role in maintaining the health and function of the eye, so damage to the cornea can significantly affect vision.

What is keratitis?

Acute keratitis represents inflammation or infection of the cornea, and can be caused by various factors: infectious agents (bacteria, viruses, fungi), mechanical factors (trauma), improper contact lens wear, or allergic factors. Ophthalmic keratitis, regardless of the cause, is a condition that must be evaluated and treated by a specialist, as it has the potential to cause severe complications if ignored.

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Ocular keratitis – causes and symptoms depending on the type of condition

Ocular keratitis can have multiple causes and manifestations, depending on the type of condition. Although the triggering factors and severity can vary, in all forms of keratitis, inflammation or infection of the cornea can affect vision and eye health. Discover the main types of keratitis and their characteristics.

Keratitis – causes and symptoms

Viral Keratitis

Infectious keratitis is caused by pathogens such as bacteria, viruses, fungi, or parasites. Depending on the microorganism involved, the manifestations and severity vary:

Bacterial Keratitis:

• is frequently associated with improper contact lens use, poor hygiene, or eye trauma. Bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa are common causes. Symptoms include intense redness, severe eye pain, light sensitivity, excessive tearing, and blurred vision. This form requires prompt treatment to prevent complications such as corneal ulceration.

Recurrent Herpetic Keratitis:

• causes lesions caused by the Herpes simplex virus (HSV). Herpetic keratitis in the eye can lead to recurrent inflammation and corneal scarring. It has symptoms similar to bacterial keratitis, but sometimes accompanied by painful ulcers or vesicles on the cornea.

Fungal Keratitis:

• usually occurs after eye trauma caused by organic materials (such as wood splinters) or through the use of contaminated contact lenses. Fungi such as Fusarium, Aspergillus, and Candida can penetrate the cornea, causing symptoms like redness, foreign body sensation, and eye pain. Fungal keratitis progresses more slowly than bacterial keratitis but requires specific antifungal treatment.

Parasitic Keratitis:

• also known as Acanthamoeba keratitis, this is a rare but severe infection caused by parasites of the genus Acanthamoeba, which can be found in contaminated water. It is characterized by severe pain, a foreign body sensation, and intense inflammation, and the treatment is difficult, with a long duration.

Non-infectious Keratitis

Non-infectious keratitis occurs in the absence of a pathogen and is usually related to mechanical factors, allergic reactions, or autoimmune conditions:

Traumatic Keratitis:

• develops as a result of eye trauma, such as corneal scratching, exposure to chemicals, or ultraviolet radiation. Symptoms include redness, tearing, light sensitivity, and eye discomfort. Depending on the severity of the trauma, it may require treatment to prevent secondary infections and speed up healing.

Exposure Keratitis:

• is the result of excessive drying of the cornea, which can occur in people who do not close their eyelids completely (a condition known as lagophthalmos). This dryness causes a burning sensation, irritation, and eye discomfort. Treatment focuses on protecting the eye and restoring corneal lubrication.

Allergic Keratitis:

• is an inflammatory reaction to contact with allergens (such as pollen, dust, or animal dander). Symptoms include itching, redness, a burning sensation, and tearing. This form of keratitis is often seasonal and requires anti-allergic treatments.

Autoimmune Keratitis:

• can occur in people with autoimmune diseases, such as Sjögren’s syndrome or rheumatoid arthritis, which affect the lacrimal glands and tear production. Symptoms include extreme dry eye, pain, and eye discomfort. Treatment involves lubricating the eye and managing the underlying autoimmune disease.

Phototoxic Keratitis

• Phototoxic keratitis is an inflammation of the cornea caused by excessive exposure to ultraviolet (UV) radiation. It is also known as “snow blindness” or “corneal sunburn.” It occurs in people exposed to intense sources of UV radiation, such as strong sunlight, without adequate protection, or working with welding equipment. Symptoms appear a few hours after exposure and include a burning sensation, eye pain, photophobia (light sensitivity), and excessive tearing. Treatment involves reducing light exposure and applying lubricating eye drops to soothe symptoms.

Neurotrophic Keratitis

• Neurotrophic keratitis occurs due to damage to the corneal nerves, which impairs the perception of pain and discomfort, reducing the eye’s normal protective reflexes. Thus, even minor injuries or irritations can progress to severe conditions. This is a rare form of keratitis, associated with neurological conditions, surgical trauma, or prolonged use of certain medications. Symptoms may be minor, but in the long term, neurotrophic keratitis can cause deep ulcers and scarring, requiring careful monitoring and specific treatment.

Superficial Punctate Keratitis

• It is a mild inflammation of the outer layer of the cornea (epithelium), characterized by small lesions or dots affecting the corneal surface. Punctate keratitis can be caused by external irritants, allergic factors, or contact lens use. Symptoms include redness, a burning sensation, eye discomfort, and light sensitivity. This form of keratitis usually responds well to lubricating and anti-inflammatory treatments.

Interstitial Keratitis

• Interstitial keratitis affects the stroma, the central layer of the cornea, and is often associated with viral infections or autoimmune diseases. Infection with syphilis or the herpes simplex virus can lead to this form of keratitis. Symptoms include blurred vision, light sensitivity, pain, and, in severe cases, corneal scarring. Treatment depends on the infectious or autoimmune cause and may include antivirals, antibiotics, or corticosteroids.

Marginal Keratitis

• Marginal keratitis is a form of inflammation of the corneal margin, usually caused by an immune reaction to bacterial toxins (e.g., Staphylococcus toxins). It is frequently encountered in people with blepharitis. Symptoms include eye discomfort, redness, and a foreign body sensation. It requires treatment with anti-inflammatories and, sometimes, topical antibiotics.

Disciform Keratitis

• It is an inflammation of the corneal stroma that causes disc-shaped edema and central opacity. It is often the result of a viral infection (such as herpes). Symptoms include blurred vision and eye discomfort. Treatment involves antivirals and corticosteroids to reduce inflammation and prevent scarring.

Lagophthalmic Keratitis

• This can be caused by lagophthalmos (inability to close the eyelids completely), associated with facial paralysis or other conditions. Symptoms include dryness, irritation, and eye discomfort. Treatment focuses on eye protection through the use of lubricants and partial or complete eyelid closure in severe cases.

Stromal Keratitis

• Stromal keratitis affects the deep layer of the cornea (stroma) and can occur as a complication of herpetic infections or autoimmune diseases. It causes deep corneal opacities, blurred vision, and pain. Treatment is complex, including corticosteroids to reduce inflammation and antivirals to prevent recurrent viral infections.

Neurotrophic Keratitis

• It is a rare form of keratitis, caused by loss of corneal sensitivity, which prevents the detection of pain and irritation. It can occur as a result of surgical interventions or nerve damage. Symptoms may be minor initially, but in the long term, the condition can cause severe corneal ulcers. Treatment involves careful monitoring and constant lubrication of the eye.

Punctate Keratitis

• Punctate keratitis is characterized by small lesions or dots on the corneal surface, often caused by external irritations or minor viral infections. Symptoms include discomfort, redness, and slightly blurred vision. It responds well to ocular lubricants and protective measures.

Chronic Superficial Keratitis

• Chronic superficial keratitis is a long-term inflammation of the corneal superficial layer, which can be associated with allergies, dry eye, or other irritative conditions. It causes constant eye irritation, discomfort, and blurred vision. Treatment is based on lubricating the eyes and avoiding trigger factors.

Keratitis in the eye – diagnostic and management methods

Considering the variety of triggering factors and the increased risk of complications, correct diagnosis and prompt management are essential. This chapter details the main diagnostic methods for keratitis. It also includes the various management and prevention options.

Keratitis and diagnostic methods – what are they?

The diagnosis of keratitis involves several ophthalmological techniques and instruments. These help identify the type of inflammation and determine the cause. Among the most used methods are:

• Slit-lamp examination: allows for a detailed evaluation of the cornea, being useful for detecting inflammation, edema, and lesions.

• Fluorescein staining: the application of this dye highlights epithelial lesions under UV light, facilitating the identification of the type and severity of keratitis.

• Microbial culture and cytological examination: collection of material from the cornea helps identify infectious agents and inflammatory characteristics, which are necessary for appropriate treatment.

• Serological tests and imaging: detect specific antibodies and provide detailed images of the stroma, essential for autoimmune cases.

• Corneal sensitivity testing: evaluation of the cornea’s nerve function is useful for diagnosing neurotrophic keratitis.

Keratitis care plan – how can it be managed effectively?

The treatment of corneal keratitis varies depending on its type and cause. In general, treatment methods aim to reduce inflammation, eliminate infection, and prevent corneal scarring.

Antimicrobial treatment for bacterial keratitis consists of administering topical antibiotics tailored to the pathogen, while for fungal or parasitic keratitis, antifungals and antiparasitics are used. In cases of herpetic keratitis and other viral infections, antivirals such as acyclovir or ganciclovir are used to limit viral replication. Corticosteroids are used with caution in non-infectious or autoimmune keratitis, but in viral keratitis, they should only be used under medical supervision.

For keratitis causing dry eye, artificial tears and lubricating gels are recommended. In severe cases, partial eyelid closure may be necessary. In severe situations or with extensive corneal scarring, corneal surgery, including corneal transplantation, may be considered to restore affected vision.

Bacterial keratitis and other forms of the condition – how can they be prevented?

Preventing severe keratitis involves a series of hygiene and eye protection measures, especially for people who wear contact lenses or have an increased risk of eye infections. Among the preventive recommendations are:

• Contact lens hygiene: adhering to hygiene and contact lens usage rules is essential for preventing bacterial and fungal infections. Lenses must be cleaned and stored correctly, and users should avoid sleeping with contact lenses unless they are specifically designed for continuous wear.

• Eye protection in contaminated environments: wearing protective eyewear in dusty or chemically exposed environments helps prevent irritation and ocular contamination.

• Prompt treatment of systemic conditions: autoimmune diseases and viral infections must be managed appropriately to reduce the risk of ocular complications.

Therefore, keratitis is a serious eye condition that requires proper diagnosis and treatment. Proper management of this inflammation can prevent severe complications, thus protecting eye health and maintaining long-term vision clarity.

References:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/keratitis

https://www.ncbi.nlm.nih.gov/books/NBK559014/

https://eyewiki.org/Bacterial_Keratitis

https://www.healthline.com/health/keratitis

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