Infectious crystalline keratopathy (ICK): Description, Causes and Risk Factors:
Fernlike, needle-shaped deposits that may be seen in bacterial keratitis, particularly that due to alpha-hemolytic streptococci, under streptococcus.
Crystalline keratopathy is a condition in which crystals are deposited in the corneal epithelium and/or anterior stroma. Affected individuals frequently present to the ophthalmologist with symptoms of pain, decreased vision or photophobia
. This condition may arise from a multitude of causes, such as infection, corneal dystrophy or systemic disease, that result in a buildup of metabolic products in the cornea.
Infectious crystalline keratopathy may occur with a bacterial infection. The infection can arise de novo or as a sequelae of surgical procedures, such as refractive surgery and corneal transplants, if the cornea is traumatized chemically or mechanically. Streptococcus viridans is the most common organism to cause crystal deposits in the cornea, however, Staphylococcus epidermidis, Streptococcus pneumoniae, Haemophilus, Enterococcus, and Candida have also been reported as causative organisms. Eyes undergoing refractive surgery are at higher risk for infections with atypical organisms such as mycobacterium (acid-fast bacteria) and Alternaria (fungi). With the increasing number of patients undergoing refractive surgery and the relevance of early intervention, it is important to recognize infectious crystalline keratopathy. It may also be seen in corneal grafts of eyes that have undergone penetrating keratoplasty and in those eyes that have an otherwise immunocompromized cornea (e.g., chronic corticosteroid use and topical anesthetic abuse).
A crystalline appearance within the stroma of the cornea may also be caused by a variety of conditions including lipid and metabolic disorders such as cystinosis and monoclonal gammopathy in association with multiple myeloma. More unexpectedly it can occur as a complication of penetrating keratoplasty following either infection or rejection.
Crystalline keratopathy is an important clinical entity that can occur secondary to a variety of causes ranging from topical medications to systemic disease. Once the diagnosis is made, the Ophthalmologist should pursue a Workup based on clinical evidence and history and establish the Etiology of the crystals in order to implement timely and appropriate therapy.
Corneal abrasion associated with hard or soft contact lenses is especially susceptible. The eye is red and painful; vision loss
is not usually immediately present, but it may occur as the corneal abrasion progresses. Permanent vision loss may occur. There is an increased risk for fulminant keratitis caused by Pseudomonas spp.
Diagnosis of ICK is primarily established by Clinical appearance on slit-lamp examination. Isolation of the infectious organism can often be difficult since the infiltrate may often lie deep within the corneal stroma, inaccessible to superficial scrapings. Needling of the crystals, culturing involved sutures, or corneal biopsy may be required. At times, a specific pathogen has only been identified after therapeutic corneal transplantation. Polymerase chain reaction has also been demonstrated to be a useful diagnostic tool.
First-line treatment of infectious crystalline keratopathy is with intensive topical antibiotics. Most corneal surgeons use "fortified" antibiotics such as cefazolin (AncefSM
) or vancomycin (VancocinTM
). When the organism has not been identified, a broad-spectrum antibiotic should be used. The antibiotic coverage should be tailored once the organism and antibiotic sensitivities have been obtained. If symptoms do not resolve, it is reasonable to expand coverage or to start systemic antibiotics. It is common for treatment of infectious crystalline keratopathy to be necessary for weeks or even months. In cases that do not resolve after penetrating keratoplasty, the Ophthalmologist may consider repeat surgical intervention as a last resort. However, the ophthalmologist must be careful since an active infection can lead to the spread of the organism into the anterior chamber with endophthalmitis.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.