keratopathy

What is Keratopathy?

Keratopathy refers to a group of diseases that affect the cornea, which is the clear, dome-shaped tissue on the front of the eye. The term "keratopathy" comes from the root words "kera," meaning cornea, and "pathy," meaning disease.

Types of Keratopathies

There are several types of keratopathies, including:

• Keratitis: An inflammation or irritation of the cornea, which can be caused by an eye condition or a systemic condition.
• Band Keratopathy: A disease process that occurs from sub-epithelial calcium hydroxyapatite deposition leading to an opaque, band-like horizontal opacity in the cornea.
• Neurotrophic Keratopathy: A rare degenerative disease of the cornea characterized by reduction or loss of corneal sensitivity.
• Exposure Keratopathy: Corneal damage due to exposure of the eye to the environment and is a sequela of untreated conditions.

Characteristics of Keratopathies

Keratopathies can be caused by various factors, including:

• Local causes such as infections or injuries
• Systemic causes such as autoimmune disorders or nutritional deficiencies
• Each keratopathy has distinct clinical features and etiopathogenesis

Symptoms and Effects

The symptoms and effects of keratopathies can vary depending on the type and severity of the condition. Some common symptoms include:

• Blurred vision
• Eye pain or discomfort
• Redness or swelling of the eye
• Corneal ulcers or opacities

If left untreated, keratopathies can lead to serious complications, including permanent vision loss.

References

[1] The term "keratopathy" comes from the root words "kera," meaning cornea, and "pathy," meaning disease. [2] Keratitis is an inflammation or irritation of the cornea. [3] Band keratopathy affects your cornea, which is normally clear and transparent. [4] Neurotrophic keratopathy is a rare degenerative disease of the cornea characterized by reduction or loss of corneal sensitivity. [5] Exposure keratopathy refers to corneal damage due to exposure of the eye to the environment.

Keratopathy Symptoms

Keratopathy, also known as corneal dystrophy, can manifest in various ways, depending on the underlying cause. Some common signs and symptoms include:

• Increased thickness of the central cornea: This is a hallmark symptom of keratopathy associated with aniridia (absence or partial absence of the iris) [1].
• Eye pain: Pain in the eye can be a symptom of keratitis, which is inflammation of the cornea. Keratitis can be caused by various factors, including infections and non-infectious conditions [2][3].
• Redness: Redness of the eye is another common symptom of keratitis, indicating inflammation or irritation [4][5].
• Foreign body sensation: This is a feeling that something is in the eye, which can be caused by keratitis or other corneal conditions [6][7].
• Blurred vision: Blurred vision can result from keratopathy due to changes in the cornea's shape or structure [8].

Other symptoms

Additional symptoms of keratitis and keratopathy may include:

• Excessive tearing
• Light sensitivity
• Decrease in vision acuity

It is essential to consult a healthcare provider for an accurate diagnosis and treatment plan, as these symptoms can be indicative of various conditions.

References: [1] - Context 1: Signs and symptoms. Keratopathy symptoms can begin to appear by age 10, but more commonly appear in the third decade. [2] - Context 2: Early signs and symptoms of keratitis include eye pain and redness. [3] - Context 7: Signs and symptoms of keratitis include: Eye pain; Eye redness; Excess tears or other discharge from your eye; [4] - Context 6: Symptoms. Symptoms of keratitis can include: Redness. Pain. Excessive tearing. [5] - Context 9: Keratitis is an inflammation of the cornea. It can arise from infectious or noninfectious origins. [6] - Context 3: Signs and symptoms of band keratopathy include: Feeling as if something is in your eye. [7] - Context 5: Feeling as if something is in your eye · Being bothered by light [8] - Context 8: The signs of neurotrophic keratitis can be tough to spot. It may present with seemingly innocuous symptoms, like blurred vision.

Keratopathy, also known as corneal dystrophy or degeneration, can be diagnosed through various diagnostic tests.

Common Diagnostic Methods

• Slit-Lamp Examination: A slit-lamp examination allows the ophthalmologist to closely inspect the cornea using a high-intensity light source and a microscope. This examination helps identify any abnormalities on the surface of the cornea.
• Eye Exam: A complete eye exam is essential in diagnosing keratopathy. The eye care provider will use bright lights and a microscope to examine the eyes, looking for signs of corneal degeneration or dystrophy.
• Corneal Scraping: Microbiological investigations such as corneal scraping for culture and sensitivity testing remain the gold standard in diagnosing infectious keratitis (IK) [6].
• Blood Tests: Renal function tests, such as blood urea nitrogen (BUN) and creatinine, should be performed to rule out systemic conditions that may contribute to keratopathy [8].

Other Diagnostic Procedures

• Corneal Surface Examination: A detailed examination of the corneal surface is essential in diagnosing neurotrophic keratopathy (NK). The ophthalmologist will look for signs of epithelial breakdown, corneal ulceration, or corneal melting.
• Specialized Stains: Nonspecific staining methods such as Papanicolaou, Giemsa, and Hematoxylin-eosin stains are used for the rapid detection of viral infection [9].
• Serological Tests: A battery of serological tests is used to identify systemic causes of aqueous deficient dry eye, which may contribute to keratopathy.

Accurate Diagnosis

Accurate diagnosis of keratopathy involves a thorough eye examination and specialized tests. The ophthalmologist will use a combination of these diagnostic methods to determine the underlying cause of the condition [11].

Treatment Options for Keratopathy

Keratopathy, also known as neurotrophic keratitis (NK), is a rare and degenerative corneal disease that can be caused by various factors, including drug toxicity. The treatment options for keratopathy depend on the stage of the disease and the underlying cause.

Topical Treatments

• Preservative-free artificial tears and ointments: These are often used as first-line treatment in Stage 1 disease to support the ocular surface and prevent progression.
• Punctal occlusion: This may be considered in conjunction with topical medications to help retain tears on the eye surface.

Minimally Invasive Corneal Neurotisation

• Cenegermin (Oxervate): This is a FDA-approved medication specifically designed for the treatment of neurotrophic keratitis. It has an excellent safety profile and can be used as a treatment option in certain cases.

Other Treatment Options

• Washout of epitheliotoxic drugs: If the keratopathy is caused by drug toxicity, stopping or reducing the dosage of the offending medication may help alleviate symptoms.
• Bandage contact lens (CL): This may be used to protect and lubricate the eye surface in cases where the cornea is compromised.

Systemic Treatments

• Medical therapy: In some cases, medical management may be the first line treatment option for band keratopathy. This typically involves addressing any underlying systemic causes or conditions that may be contributing to the disease.

Important Considerations

• Early diagnosis and treatment: Prompt intervention is crucial in preventing progression of the disease.
• Individualized treatment plans: Treatment options should be tailored to the specific needs and circumstances of each patient.

References:

[3] Stage 1 disease is generally treated with preservative-free artificial tears and ointments as well as consideration of punctal occlusion. [5] Washout of epitheliotoxic drugs and lubrication with preservative-free artificial tears and ointments, often in combination with the use of bandage contact lens (CL), are the first line of NK treatment. [13] The US Food and Drug Administration today approved the first drug, Oxervate (cenegermin), for the treatment of neurotrophic keratitis, a rare disease affecting the cornea.

Differential Diagnosis of Keratopathy

Keratopathy, also known as neurotrophic keratopathy, is a condition characterized by corneal thinning and ulceration due to decreased corneal sensation. The differential diagnosis of keratopathy involves considering various conditions that can present with similar symptoms.

• Corneal Ulcer: A bacterial or fungal infection of the cornea can mimic the symptoms of keratopathy, including corneal thinning and ulceration [13].
• Keratitis: Inflammation of the cornea can also be a differential diagnosis for keratopathy, particularly if it presents with corneal edema and infiltration of inflammatory cells [2].
• Dry Eye Disease: Exposure keratopathy, a severe variant of dry eye disease, can present with similar symptoms to keratopathy, including corneal thinning and ulceration [11].
• Lipid Keratopathy: A rare ophthalmological disorder that can cause corneal opacification and progressive painless visual acuity decline, which may be confused with keratopathy [8, 12].
• Metabolic Keratopathy: A condition associated with metabolic disorders, such as mucopolysaccharidosis (MPS), which can present with bilateral and diffuse corneal opacification, similar to keratopathy [10].

It is essential to consider these differential diagnoses when evaluating patients with suspected keratopathy. A thorough history, physical examination, and diagnostic procedures, such as slit-lamp biomicroscopy, are necessary to determine the correct diagnosis.

References: [2] - Keratitis is characterized by corneal edema, infiltration of inflammatory cells, and ciliary congestion. [8] - Lipid keratopathy is a rare ophthalmological disorder that should be considered in the differential diagnosis of corneal opacification and progressive painless visual acuity decline. [10] - Metabolic keratopathy: Being bilateral and diffuse in cases of MPS, it may get confused with corneal dystrophies like congenital hereditary endothelial dystrophy or congenital hereditary stromal dystrophy. [11] - An overview of the differential diagnosis and treatment options for this severe variant of dry eye disease. [12] - Lipid keratopathy is a rare ophthalmological disorder that should be considered in the differential diagnosis of corneal opacification and progressive painless visual acuity decline. [13] - Bacterial keratitis or corneal ulcer is an infection of the corneal tissue caused by varied bacterial species.