Summary about Disease
Keratic precipitates (KPs) are cellular deposits, primarily composed of inflammatory cells, that adhere to the posterior surface of the cornea. They are a hallmark sign of anterior uveitis, which is inflammation of the middle layer of the eye (iris, ciliary body, and choroid). KPs can vary in size, shape, and distribution depending on the underlying cause of the uveitis. They are a secondary finding, reflecting the inflammatory process in the anterior chamber.
Symptoms
KPs themselves are not directly symptomatic. However, the underlying uveitis causing the KPs will present with symptoms that may include:
Eye pain
Redness
Blurred vision
Light sensitivity (photophobia)
Floaters
Decreased vision
Causes
KPs are caused by underlying inflammatory conditions affecting the anterior uvea. Common causes include:
Infections: Herpes simplex virus (HSV), varicella-zoster virus (VZV), syphilis, tuberculosis (TB)
Autoimmune diseases: Sarcoidosis, rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), Behcet's disease.
Idiopathic uveitis: In many cases, the cause of uveitis remains unknown.
Other: Trauma, surgery
Medicine Used
Treatment focuses on addressing the underlying cause of the uveitis and reducing inflammation. Medications may include:
Corticosteroid eye drops: To reduce inflammation in the eye (e.g., prednisolone acetate, dexamethasone)
Cycloplegic eye drops: To dilate the pupil and relieve pain (e.g., atropine, cyclopentolate)
Oral corticosteroids: For more severe inflammation (e.g., prednisone)
Immunosuppressants: In cases of autoimmune-related uveitis (e.g., methotrexate, azathioprine, adalimumab)
Antiviral medications: For viral infections (e.g., acyclovir, valacyclovir)
Antibiotics: For bacterial infections
Is Communicable
KPs themselves are not communicable. However, if the underlying cause of the uveitis is an infection (e.g., herpes, syphilis, tuberculosis), the infectious agent may be communicable, depending on the mode of transmission of that particular infection. The uveitis itself would not be directly transmitted.
Precautions
Precautions depend on the underlying cause of the KPs and uveitis. General recommendations include:
Following the treatment plan prescribed by your doctor, including medications.
Wearing sunglasses to protect your eyes from light sensitivity.
Avoiding activities that could further irritate the eye.
Practicing good hygiene to prevent the spread of any underlying infection.
If the cause is related to an underlying systemic condition, managing that condition according to your doctor's recommendations.
How long does an outbreak last?
The duration of a uveitis outbreak with KPs varies significantly depending on the underlying cause, the severity of the inflammation, and how well the condition responds to treatment. Acute uveitis may resolve within weeks to months with treatment. Chronic uveitis can persist for months to years, often with periods of flare-ups and remissions.
How is it diagnosed?
Diagnosis involves a comprehensive eye examination by an ophthalmologist. The exam typically includes:
Slit-lamp examination: To visualize the KPs on the cornea.
Intraocular pressure measurement: To check for glaucoma.
Dilated fundus examination: To examine the retina and other parts of the eye.
Additional tests: To determine the underlying cause, such as blood tests for infections or autoimmune markers, chest X-rays, or other imaging studies.
Timeline of Symptoms
The timeline of symptoms can vary. Acute uveitis often presents with a rapid onset of symptoms (days to weeks), while chronic uveitis develops more gradually over weeks to months.
Early symptoms: Eye pain, redness, blurred vision, light sensitivity.
Progression: KPs become visible on examination, inflammation worsens, vision may decrease further.
Resolution: With treatment, inflammation subsides, and KPs may gradually clear. However, recurrence is possible.
Important Considerations
Early diagnosis and treatment are crucial to prevent complications such as glaucoma, cataracts, and vision loss.
It is important to identify and treat the underlying cause of the uveitis to prevent recurrences.
Long-term follow-up with an ophthalmologist is necessary to monitor for complications and manage chronic uveitis.
Systemic conditions associated with uveitis require management by a rheumatologist or other specialist.
Patient education and adherence to treatment are essential for successful management.