Keratitis

Classification according to ICD-10
H16	Keratitis
ICD-10 online (WHO version 2019)

A keratitis (of Greek keratos "cornea") is an inflammation of the cornea of the eye and can be triggered by a wide variety of causes. Forwarded as part of conjunctivitis ( conjunctivitis ), it can develop into keratoconjunctivitis . A combined inflammation of the tear sac ( dacryocystitis ) is also possible. In this respect, keratitis can encompass numerous different clinical pictures.

Symptoms

The clinical picture of keratitis can vascularization (ciliary injections), Chemosen , infiltrates and cloudiness as well as neovascularization ( vascularization ) and tumors ( corneal ulcer have). It is not uncommon for it to be accompanied by inflammation of the iris ( iritis ). In contrast to conjunctivitis , keratitis is not associated with noticeably increased secretion .

Subjective complaints are expressed, among other things, in severe pain , redness of the eyes with a feeling of foreign bodies, photophobia and deterioration in visual acuity . Irritation and pain are caused by the sensitive supply of the cornea by the nasociliary nerve .

Causes and forms

The etiology of keratitis is diverse. Possible causes are:

chemical: acids or alkalis

physical: UV radiation when sunbathing or arc welding, often with accompanying conjunctivitis

mechanical: foreign body introduced into the conjunctival fold , lagophthalmos

genetic: KID syndrome

biological: bacteria ( Staphylococcus aureus , Pseudomonas aeruginosa , Streptococcus pneumoniae , Listeria monocytogenes ); Fungi ( Candida spp. , Spp Aspergillus. Especially after antibiotic therapy, or glucocorticoid - eye drops , Fusarium spp. Associated with contact lens use); Viruses (e.g. keratitis disciformis caused by herpes viruses ), amoeba ( acanthamoeba )

neurological: neurotrophic keratopathy caused by damage to the trigeminal nerve

congenital: autosomal dominant keratitis

Another highly infectious form is keratitis epidemica . Triggered by an adenovirus , it is extremely contagious and as such must be reported .

therapy

In principle, an ophthalmologist should always be consulted with keratitis . Basic therapeutic measures depend on the respective cause. A possible accompanying iritis should also be treated. Antimicrobial therapy takes place depending on whether an infection by bacteria, fungi or parasites (for example Acanthamoeba ) is the cause.

literature

Albert J. Augustin: Ophthalmology. 3. Edition. Springer, 2007, ISBN 978-3-540-30454-8 .
T. Axenfeld (start.), H. Pau (ed.): Textbook and atlas of ophthalmology. With the collaboration of R. Sachsenweger and others Gustav Fischer Verlag, Stuttgart 1980, ISBN 3-437-00255-4 .

Individual evidence

↑ DC Chang, GB Grant, K. O'Donnell, KA Wannemuehler, J. Noble-Wang, CY Rao, LM Jacobson, CS Crowell, RS Sneed, FM Lewis, JK Schaffzin, MA Kainer, CA Genese, EC Alfonso, DB Jones, A. Srinivasan, SK Fridkin, B. ParkJ ;: Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution . In: JAMA . tape 296 , no. 8 , 2006, p. 953-963 , PMID 16926355 (English).
^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 113-115 ( keratitis ).

[1] DC Chang, GB Grant, K. O'Donnell, KA Wannemuehler, J. Noble-Wang, CY Rao, LM Jacobson, CS Crowell, RS Sneed, FM Lewis, JK Schaffzin, MA Kainer, CA Genese, EC Alfonso, DB Jones, A. Srinivasan, SK Fridkin, B. ParkJ ;: Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution . In: JAMA . tape 296 , no. 8 , 2006, p. 953-963 , PMID 16926355 (English).

[2] Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 113-115 ( keratitis ).