Summary about Disease
Keratouveitis is an inflammatory condition affecting both the cornea (kerato-) and the uvea (-uveitis). The uvea is the middle layer of the eye, consisting of the iris, ciliary body, and choroid. The inflammation can be infectious or non-infectious in origin and can lead to significant visual impairment if not properly managed. The condition can be unilateral (affecting one eye) or bilateral (affecting both eyes).
Symptoms
Symptoms of keratouveitis can vary depending on the severity and underlying cause. Common symptoms include:
Eye pain (ranging from mild ache to intense throbbing)
Redness of the eye
Sensitivity to light (photophobia)
Blurred vision or decreased vision
Tearing or excessive watering of the eye
Small or irregular pupil shape
Floaters (dark spots or lines in your vision)
Corneal clouding or opacity
Headache
Causes
Keratouveitis can be caused by various factors, including:
Infections: Herpes simplex virus (HSV), Varicella-zoster virus (VZV), Cytomegalovirus (CMV), bacteria (e.g., Staphylococcus, Streptococcus), fungi, and parasites (e.g., Toxoplasmosis).
Autoimmune diseases: Sarcoidosis, rheumatoid arthritis, lupus, ankylosing spondylitis, Behçet's disease.
Trauma: Injury to the eye.
Idiopathic: In some cases, the cause remains unknown.
Other Inflammatory Conditions: Inflammatory bowel disease, multiple sclerosis.
Medicine Used
The medications used to treat keratouveitis depend on the underlying cause:
Antiviral Medications: Acyclovir, valacyclovir, famciclovir (for viral infections like HSV or VZV). Ganciclovir or foscarnet for CMV.
Antibiotics: Topical or oral antibiotics for bacterial infections.
Antifungal Medications: Topical or oral antifungals for fungal infections.
Corticosteroids: Topical (eye drops like prednisolone acetate, dexamethasone) or oral/intravenous corticosteroids to reduce inflammation.
Cycloplegic Agents: Atropine or cyclopentolate eye drops to dilate the pupil, relieve pain, and prevent complications.
Immunosuppressants: Methotrexate, azathioprine, cyclosporine, or biologics (e.g., adalimumab, infliximab) for autoimmune-related cases.
Pain Relievers: Over-the-counter pain relievers or prescription pain medications for pain management.
Is Communicable
Keratouveitis itself is not typically communicable. However, if the underlying cause is an infectious agent (such as HSV, VZV, or certain bacteria), then the infectious agent can be transmitted, potentially leading to keratouveitis or other infections in the new host. The specific mode of transmission depends on the infectious agent involved.
Precautions
Precautions depend on the underlying cause:
Infectious Keratouveitis: Good hygiene practices (frequent hand washing) to prevent the spread of the infection. Avoid sharing towels or personal items. Follow doctor's instructions for medication and isolation (if recommended).
Non-Infectious Keratouveitis: Protect your eyes from irritants and trauma. Manage underlying autoimmune conditions. Follow doctor's instructions for medication and follow-up appointments. Wear sunglasses to reduce light sensitivity.
General Precautions: Avoid rubbing your eyes. Use artificial tears to keep eyes lubricated. Attend all scheduled follow-up appointments with your ophthalmologist.
How long does an outbreak last?
The duration of a keratouveitis outbreak varies depending on the cause and the effectiveness of treatment.
Infectious: Viral infections (like HSV or VZV) may resolve in weeks to months with antiviral treatment. Bacterial or fungal infections may improve more rapidly with appropriate antibiotics or antifungals.
Non-Infectious: Autoimmune-related keratouveitis can be chronic with periods of exacerbation and remission. The duration of an outbreak can vary from weeks to months or even longer. Management focuses on controlling the inflammation and preventing recurrence.
It is important to follow your doctor's treatment plan to decrease the outbreak and duration of the symptoms.
How is it diagnosed?
Diagnosis of keratouveitis involves a comprehensive eye examination by an ophthalmologist:
Slit-lamp Examination: To examine the cornea, iris, and other structures of the eye under high magnification.
Intraocular Pressure Measurement: To check for glaucoma (increased eye pressure).
Dilated Eye Exam: To examine the retina and other structures at the back of the eye.
Fluorescein Angiography: To evaluate blood vessel abnormalities in the retina and choroid.
Laboratory Tests: Blood tests may be performed to check for infections (e.g., viral titers) or autoimmune diseases (e.g., rheumatoid factor, ANA).
Corneal Scraping or Biopsy: In certain cases, a sample from the cornea may be taken for culture or analysis to identify the infectious agent.
Imaging: MRI or CT scans may be used to rule out other conditions.
Timeline of Symptoms
The timeline of symptoms can vary depending on the cause:
Acute Onset: Infectious causes (HSV, VZV, bacteria) often have a rapid onset of symptoms (over a few days).
Gradual Onset: Autoimmune-related cases may have a more gradual onset of symptoms (over weeks or months).
Recurrent: Some individuals may experience recurrent episodes of keratouveitis, especially if the underlying cause is not fully addressed.
Symptoms can progress quickly if untreated, thus immediate evaluation and treatment is necessary to alleviate the symptoms and decrease the duration.
Important Considerations
Early Diagnosis and Treatment: Prompt diagnosis and appropriate treatment are essential to prevent complications and vision loss.
Compliance with Treatment: Follow your ophthalmologist's instructions carefully and take all medications as prescribed.
Regular Follow-up: Attend all scheduled follow-up appointments to monitor your condition and adjust treatment as needed.
Underlying Conditions: Management of any underlying autoimmune or infectious diseases is crucial for controlling keratouveitis.
Potential Complications: Untreated keratouveitis can lead to glaucoma, cataracts, corneal scarring, vision loss, and other serious complications.
Multidisciplinary Approach: Some patients may require a multidisciplinary approach involving ophthalmologists, rheumatologists, and infectious disease specialists.
Medication Side Effects: Be aware of potential side effects of medications and report any concerns to your doctor.
Eye Protection: Protect your eyes from sunlight and trauma. Wear protective eyewear when participating in activities that could cause eye injury.