Keratitis profunda

Keratitis profunda: Description, Causes and Risk Factors: Keratitis profunda Alternative Name: Diffuse deep keratitis, interstitial keratitis, parenchymatous keratitis. An inflammation of the posterior corneal stroma. Keratitis profunda is a serious condition in which blood vessels grow into the cornea. Such growth can cause loss of the normal transparency (clarity) of the cornea. This condition is often caused by infections and may cause severe visual problems. Syphilis is the most common cause of keratitis profunda, but rare causes include leprosy and tuberculosis. Most cases in the developed world occur in patients with fully established syphilis. It is an immune-mediated process thought to be caused by a cellular and humoral response against antigens in the corneal stroma, residual infectious antigens or both. The presence of mainly T cells in pathological specimens from corneas with keratitis profunda suggest a role of this population of cells in this disease. The inflammatory lesions of keratitis profunda can present clinically as active or inactive. In active keratitis profunda, there is an on-going immune-mediated inflammation characterized by stromal infiltration, edema and in some cases the presence of an immune-ring reaction. Inactive keratitis profunda is defined by the evidence of previous episode of stromal inflammation, which has remained quiet for a period of at least one year. Risk Factors May include: Congenital syphilis.
  • Acquired syphilis.
  • Tuberculosis.
  • Leprosy.
  • Lyme disease.
  • Herpes simplex virus.
  • Herpes zoster virus.
  • Human T-lymphotrophic virus Type I (HTLV-I)
  • Leishmaniasis.
  • Trypanosomiasis.
  • Cogan`s syndrome.
Symptoms: The typical corneal findings include mid or deep stromal scarring and sometimes reduplication of Descemet's membrane. Deep neovascularization of the stroma can also be seen in keratitis profunda, resulting in the formation of ghost blood vessels in the absence of blood flow in chronic cases. General symptoms: Eye pain.
  • Excessive tearing.
  • Photophobia (sensitivity to light).
Diagnosis: keratitis profunda can be easily diagnosed by physical examination of the eyes with slit-lamp examination. Blood tests and chest x-rays will usually be needed to confirm the infection causing the condition. The specific etiology must be determined. The stigmas of congenital syphilis, vestibuloauditory symptoms, history of an expanding rash, and tick exposure support a specific etiology. However, all patients should have serologic testing, including all of the following: Fluorescent treponemal antibody absorption test or the microhemagglutination assay for Treponema pallidum.
  • Lyme titer.
  • Epstein-Barr virus panel.
  • Patients with negative serologic test results may have Cogan's syndrome, an idiopathic syndrome consisting of interstitial keratitis and vestibular and auditory deficits. To prevent permanent vestibuloauditory damage, symptoms of hearing loss, tinnitus, or vertigo require referral to an otolaryngologist.
Treatment: The underlying disease must be treated. Treatment of the cornea with corticosteroid drops may minimize scarring and help preserve the clarity of the cornea. Once the clear covering of the cornea is gone, a corneal transplantation may be required. 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.

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