Summary about Disease
Keratoendotheliitis refers to inflammation affecting both the cornea (kerato-) and the endothelium of the eye. It's not a single, well-defined disease but rather a descriptive term encompassing various inflammatory conditions affecting these structures. These conditions can lead to pain, vision changes, and potentially long-term corneal damage if left untreated. The specific type and severity of keratoendotheliitis will determine the treatment and prognosis.
Symptoms
Symptoms of keratoendotheliitis can vary depending on the underlying cause and the severity of the inflammation. Common symptoms may include:
Eye pain
Redness of the eye
Blurred vision
Sensitivity to light (photophobia)
Watering of the eye (excessive tearing)
Feeling of something in the eye (foreign body sensation)
Decreased vision
Halos around lights
Causes
Keratoendotheliitis can be caused by a variety of factors, including:
Viral infections: Herpes simplex virus (HSV), herpes zoster virus (HZV), adenovirus
Bacterial infections: Less common but possible
Fungal infections: Rare, but can occur, especially after corneal injury
Immune-mediated diseases: Sarcoidosis, rheumatoid arthritis, inflammatory bowel disease, other autoimmune conditions
Trauma: Injury to the cornea
Surgery: Post-surgical inflammation
Contact lens wear: Especially with poor hygiene
Unknown causes: In some cases, the cause cannot be identified (idiopathic)
Medicine Used
The medications used to treat keratoendotheliitis depend entirely on the underlying cause:
Antiviral medications: Acyclovir, valacyclovir, famciclovir (for HSV or HZV) - administered orally, topically, or intravenously.
Antibacterial medications: Topical or oral antibiotics (for bacterial infections).
Antifungal medications: Topical or oral antifungals (for fungal infections).
Corticosteroid eye drops: Prednisolone, dexamethasone (to reduce inflammation, but used cautiously due to potential side effects).
Cycloplegic eye drops: Atropine, cyclopentolate (to relieve pain and prevent adhesions).
Artificial tears: To lubricate the eye and reduce irritation.
Immunosuppressants: In severe cases, oral medications like methotrexate, azathioprine, or cyclosporine may be used for immune-mediated causes.
Is Communicable
Whether or not keratoendotheliitis is communicable depends on the underlying cause.
Infectious causes (viral, bacterial, fungal): Can be communicable, especially viral infections like herpes simplex keratitis or adenoviral conjunctivitis. Transmission occurs through direct contact with infected eye secretions.
Non-infectious causes (immune-mediated, trauma, etc.): Not communicable.
Precautions
If the keratoendotheliitis is caused by an infectious agent, the following precautions should be taken to prevent the spread of the infection:
Good hand hygiene: Wash hands frequently with soap and water.
Avoid touching the eyes: Especially without washing hands.
Do not share towels, washcloths, or eye makeup: These items can harbor infectious agents.
Disinfect surfaces: Clean surfaces that may have come into contact with eye secretions.
Avoid close contact: Limit close contact with others, especially young children, elderly individuals, and those with weakened immune systems.
Follow doctor's instructions: Adhere to prescribed medications and follow-up appointments.
Contact lens wearers: Discontinue contact lens wear until the infection has cleared and consult with your eye doctor about proper lens care and hygiene. For non-infectious causes, general precautions to protect the eyes are advised:
Wear protective eyewear in situations with potential eye injury (e.g., sports, construction).
Proper contact lens care.
Manage underlying systemic diseases that could contribute to eye inflammation.
How long does an outbreak last?
The duration of a keratoendotheliitis outbreak varies greatly depending on the cause, severity, and treatment response:
Viral infections (e.g., herpes simplex): Can last from a few weeks to several months, with potential for recurrences.
Bacterial infections: Typically resolve within a week or two with appropriate antibiotic treatment.
Fungal infections: Can be chronic and difficult to treat, potentially lasting for months or even years.
Immune-mediated causes: The duration depends on the control of the underlying systemic disease. Outbreaks may be recurrent and can last for weeks, months, or longer.
Post-surgical inflammation: Usually resolves within a few weeks with topical corticosteroids.
How is it diagnosed?
Diagnosis of keratoendotheliitis typically involves a comprehensive eye examination by an ophthalmologist. This may include:
Slit-lamp examination: A microscopic examination of the cornea, endothelium, and other eye structures.
Visual acuity testing: To assess the sharpness of vision.
Intraocular pressure measurement: To rule out glaucoma.
Corneal staining: Using dyes such as fluorescein to highlight corneal defects.
Confocal microscopy: To examine the corneal endothelium at a cellular level.
Anterior segment optical coherence tomography (OCT): Imaging of the anterior segment.
Corneal scraping or biopsy: To obtain a sample for laboratory testing (e.g., viral culture, bacterial culture, fungal culture) if an infection is suspected.
Blood tests: To evaluate for underlying systemic diseases.
Review of medical history: To identify potential risk factors or underlying conditions.
Timeline of Symptoms
The timeline of symptoms depends heavily on the underlying cause:
Infectious causes: Symptoms often develop rapidly over a few days to a week. Initial symptoms may include redness, pain, and blurred vision, which can worsen quickly.
Immune-mediated causes: Symptoms may develop more gradually over weeks or months. Periods of exacerbation and remission are common.
Trauma: Symptoms typically appear immediately after the injury.
Post-surgical: Symptoms usually present within days to weeks after the procedure.
Important Considerations
Prompt diagnosis and treatment are crucial: Early intervention can help prevent permanent vision loss and corneal damage.
Underlying cause identification: Identifying the underlying cause is essential for effective treatment.
Potential for recurrence: Some causes of keratoendotheliitis, such as herpes simplex keratitis, have a high risk of recurrence.
Complications: Possible complications include corneal scarring, neovascularization (abnormal blood vessel growth in the cornea), glaucoma, and vision loss.
Long-term follow-up: Regular eye examinations are important to monitor for complications and recurrences.
Systemic disease management: If keratoendotheliitis is associated with an underlying systemic disease, managing that disease is essential for controlling eye inflammation.
Medication side effects: Corticosteroid eye drops can have side effects, such as increased intraocular pressure and cataract formation. Long-term use should be closely monitored.