filamentary keratitis

Filamentary Keratitis: A Condition Characterized by Corneal Filaments

Filamentary keratitis is a chronic corneal condition characterized by the presence of multiple filaments attached to areas of compromised corneal epithelium [5]. These filaments can cause significant discomfort, foreign-body sensation, and eye pain [8][11].

Causes and Associations

The etiology of filamentary keratitis is related to an alteration in the components of the tear film and/or abnormalities of the ocular surface [1]. It is commonly caused by conditions that decrease the moisture content or increase the friction of the ocular surface, such as dry eye disease, superior limbic keratoconjunctivitis, graft versus host disease (GVHD), Stevens-Johnson syndrome, and other autoimmune conditions [3][4].

Symptoms

Patients with filamentary keratitis often complain of foreign-body sensation, irritation, and eye pain. The condition can also cause significant tearing and photophobia [14].

Key Points to Remember

• Filamentary keratitis is a chronic corneal condition characterized by the presence of multiple filaments attached to areas of compromised corneal epithelium.
• The condition is commonly caused by conditions that decrease the moisture content or increase the friction of the ocular surface, such as dry eye disease and other autoimmune conditions.
• Patients with filamentary keratitis often complain of foreign-body sensation, irritation, and eye pain.

References

[1] Context result 1 [3] Context result 3 [4] Context result 4 [5] Context result 5 [8] Context result 8 [11] Context result 11 [14] Context result 14

Common Signs and Symptoms of Filamentary Keratitis

Filamentary keratitis, a condition characterized by the presence of filaments on the corneal surface, can exhibit several signs and symptoms. These include:

• Multiple filamentary attachments firmly adherent to the corneal surface: This is a hallmark sign of filamentary keratitis, as mentioned in [1].
• Ocular hyperemia (redness): Redness of the eye is often associated with filamentary keratitis, as noted in [2].
• Decreased corneal sensation: A decrease in corneal sensitivity can be observed in individuals with filamentary keratitis, according to [4].
• Corneal filaments and mucous debris: The presence of filaments and mucous debris on the cornea is a common finding in patients with filamentary keratitis, as described in [4] and [5].
• Superficial punctate keratopathy: This condition can also be associated with filamentary keratitis, as mentioned in [4].
• Punctate epithelial erosions: Erosions of the corneal epithelium can occur in individuals with filamentary keratitis, according to [4] and [5].
• Foreign body sensation and eye pain: Patients with filamentary keratitis often experience symptoms such as foreign body sensation and eye pain, as noted in [3], [5], and [7].

These signs and symptoms can vary in severity and may be accompanied by other ocular conditions. It is essential to consult a healthcare professional for an accurate diagnosis and treatment plan.

References: [1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [4] - Context result 4 [5] - Context result 8

Diagnostic Tests for Filamentary Keratitis

Filamentary keratitis can be diagnosed through a combination of clinical history, slit lamp examination, and other diagnostic tests.

• Slit Lamp Examination: A slit lamp exam is essential in diagnosing filamentary keratitis. It helps to visualize the corneal surface and identify firmly adherent filaments [1].
• Schirmer Test: The Schirmer test measures tear production and can help establish a diagnosis of dry eye syndrome, which may be associated with filamentary keratitis [3].

Other diagnostic tests that may be used in conjunction with these methods include:

• Corneal scraping: A corneal scraping may be performed to collect a sample for further examination under a microscope.
• Immunohistochemical technique: This technique can be used to clarify the exact composition of the corneal filament in filamentary keratitis [8].

References

[1] Context 1: The diagnosis of filamentary keratitis is made clinically with history and slit lamp exam.

[3] Context 3: The Schirmer test measures tear production and helps in diagnosing dry eye conditions that can lead to filamentary keratitis.

[8] Context 8: In this study, an immunohistochemical technique was used to clarify the exact composition of the corneal filament in filamentary keratitis.

Treatment Options for Filamentary Keratitis

Filamentary keratitis, a condition characterized by the presence of fine filaments on the corneal surface, can be challenging to treat. However, various drug treatments have been shown to be effective in managing this condition.

• Corticosteroids: Short-term use of corticosteroids such as Lotemax has been widely advocated for treating filamentary keratitis [1]. These medications can help reduce inflammation and alleviate symptoms.
• Non-steroidal agents: Anti-inflammatory drugs like non-steroidal agents have also been used to treat filamentary keratitis, often with clinical success [9].
• Acetylcysteine: This medication has shown some success in treating filamentary keratitis due to its mucolytic properties [9]. It can help break down the filaments and reduce symptoms.
• OnabotulinumtoxinA injection: OnabotulinumtoxinA injection has been found to be an effective option for treating refractory filamentary keratitis [6].
• Topical corticosteroids: Long-term treatments for underlying inflammation involve the use of topical corticosteroids, although these drugs have significant side effects [7].

Other Treatment Options

In addition to drug treatment, other options such as lubrication, mechanical removal of filaments, and therapeutic contact lenses may also be considered [4]. However, it's essential to address the underlying condition causing the corneal filaments to form for effective long-term management.

References:

[1] - Short-term use of corticosteroids has been widely advocated for treating filamentary keratitis. [6] - OnabotulinumtoxinA injection has been found to be an effective option for treating refractory filamentary keratitis. [7] - Long-term treatments for underlying inflammation involve the use of topical corticosteroids. [9] - Anti-inflammatory drugs like non-steroidal agents have also been used to treat filamentary keratitis, often with clinical success.

Differential Diagnosis of Filamentary Keratitis

Filamentary keratitis (FK) is a clinical sign that can be associated with various underlying ocular and systemic conditions. The differential diagnosis for FK includes:

• Dry Eye Disease: This is the most common cause of FK, characterized by tear film abnormalities and ocular surface damage [6][11].
• Keratoconjunctivitis Sicca (KCS): A condition where there is a decrease in tear production, leading to FK [8].
• Superior Limbic Keratoconjunctivitis (SLK): A condition characterized by inflammation of the superior limbic area, which can lead to FK [8].
• Tear Film Abnormalities: Alterations in the composition or function of the tear film can contribute to FK [10].
• Lid Malpositions: Abnormalities in eyelid position or movement can lead to FK [10].
• Previous Ocular Surgery: Surgical procedures on the eye can cause FK as a complication [10].
• Toxic Keratopathies: Exposure to toxic substances can cause damage to the cornea, leading to FK [10].

Other Conditions

In addition to these common causes, FK has been associated with various other conditions, including:

• Demodex Infestation: A case report highlighted the importance of Demodex mites as an easily-overlooked risk factor for FK [4].
• Epithelial Basement Membrane Dystrophy (EBMD): This is a rare condition that can cause FK [5].
• Meesmann Epithelial Corneal Dystrophy: Another rare condition that can lead to FK [5].

Diagnosis

The diagnosis of FK involves a comprehensive eye examination, including slit-lamp biomicroscopy to visualize the characteristic filaments on the cornea's surface. Special staining with rose bengal or lissamine green dyes may help highlight the filaments and assess the extent of ocular surface damage [15].

References:

[4] - A case report highlighting the importance of Demodex mites as an easily-overlooked risk factor for FK. [5] - Rare conditions that can cause FK, including EBMD and Meesmann epithelial corneal dystrophy. [6] - Dry eye disease is a common cause of FK. [8] - KCS and SLK are other conditions associated with FK. [10] - Tear film abnormalities, lid malpositions, previous ocular surgery, and toxic keratopathies can contribute to FK. [11] - FK is characterized by the presence of filaments on the corneal surface that are often associated with symptoms of foreign body sensation, irritation, and eye pain. [15] - Diagnosis involves a comprehensive eye examination, including slit-lamp biomicroscopy.