Corneal inflammation, also known as keratitis, is an inflammatory change in the cornea of the eye. It is associated with pain, decreased tear flow, increased sensitivity to light, and a reduction in vision. In most cases, corneal inflammation heals without consequences – however, if treatment is not received for an extended period of time, transplantation may even be necessary.
What is corneal inflammation?
In normal condition, the cornea of the eye is a clear tissue consisting of several layers. Its inflammation can be caused by various reasons. The degree of this corneal inflammation varies from case to case, extending only to one or even to several layers of the cornea. In case it is limited to the surface, it is mainly characterized by a slight opacity. This opacity becomes denser the more layers are affected. Since the condition of the cornea has a significant effect on vision, timely treatment of the disease is imperative. This is the only way to prevent consequential scarring or corneal detachment and allow the corneal inflammation to heal without complications.
Causes
Typical triggers of corneal inflammation are infections caused by bacteria or viruses, fungal infections, hereditary predisposition and injuries to the eye. In addition, however, the inflammation can also appear as a concomitant of an underlying disease such as diabetes mellitus or an HIV infection. Caution in dealing with other people is always advisable if the corneal inflammation has been triggered by an infection: Transmission of the respective pathogens is possible. A-Streptococcus, Pseudomonas, Staphylococcus or Chlamydia are often associated with such an inflammation. Herpes or adenoviruses are also known to cause an inflammatory change of the cornea. Less common, on the other hand, is infestation with fungi. In addition to the causes already mentioned, corneal inflammation can also be caused by dry eyes, a chemical burn or the influence of UV rays.
Symptoms, complaints and signs
A number of different symptoms can occur in the course of corneal inflammation. They vary greatly depending on the specific cause of keratitis and can be of varying intensity. A typical sign of corneal inflammation is severe eye pain. These are usually accompanied by impaired vision and a more light-sensitive eye. If the affected person looks directly into the light, the complaints increase markedly. Another characteristic of keratitis is a persistent foreign body sensation in the affected eye. As a result, the affected person often reflexively squeezes the eye shut. This leads to eyelid spasm (blepharospasm). This is accompanied by a strong trickling of tears and possibly also a watery or purulent secretion. The eye is usually clearly reddened. While at the beginning of the disease only a cloudiness can be seen in the eye, in the advanced stage a particularly prominent redness can be seen. In some cases, tissue damage or tumors are also visible on the cornea. In the case of hereditary corneal inflammation (keratitus bullosa), the cornea of the eye may become blistered. There is a risk that these blisters may burst, causing further pain.
Diagnosis and course
Because corneal inflammation is generally associated with pain, a reduction in vision, and significantly decreased lacrimation, most people seek medical attention within a short period of time. This is an important and indispensable step due to the consequences associated with prolonged non-treatment. The physician uses various examination methods to make a diagnosis. The initial suspicion arises from the questioning of the patient and the symptoms of the disease. With the help of the special illumination of a rod lamp, the eye is then subjected to a detailed examination, which reveals changes inside the eyeball. Vesicle formation, proliferation, corneal detachment and injury as well as opacities can be clearly identified. The examination known as the Schirmer test, which can be used to determine the tear flow, can also contribute to the diagnosis.A swab of the conjunctiva also gives the doctor information about whether it is an infectious corneal inflammation and which pathogen has triggered it.
If the disease is recognized and treated in time, a healing without consequences can be expected. However, if no treatment is given over a long period of time, corneal inflammation can have far-reaching consequences and may even require transplantation.
Complications
Corneal inflammation causes pain in the eye in most cases. This pain also occurs in the form of pain at rest and can thus very negatively affect the daily life of the affected person. It is not uncommon for this to lead to irritability and psychological discomfort and depression. Pain at rest can also lead to sleep problems at night. Furthermore, corneal inflammation also has a negative effect on the visual acuity of the affected person. In the worst case, the patient may go completely blind. The sensitivity of the eye to light also increases. The eyes are dry and the tear flow is greatly reduced. This can lead to complications if there is a foreign body in the eye and adequate tear flow is not available. The cornea usually becomes cloudy due to the inflammation. No particular complications usually occur during treatment. The corneal inflammation is treated with the help of antibiotics and other medications and leads relatively quickly to success. Furthermore, eye drops may be necessary to treat the inflammation. The disease does not affect the life expectancy of the patient. After treatment, the symptoms usually disappear completely.
When should you go to the doctor?
If symptoms such as sensitivity to light, visual disturbances, and eye pain occur, corneal inflammation may be underlying. A doctor should be consulted if symptoms persist for more than a few days. If further signs of corneal inflammation develop, it is best to consult an ophthalmologist immediately. Contact lens wearers should remove their contact lenses immediately and protect their eyes from further irritation. At the latest when a white or gray haze is noticed on the corneal surface, medical advice is needed. Other warning signs are purulent discharge and an increasing feeling of pressure in the area of the eyes. To avoid further complications, these symptoms must be seen by a doctor immediately. In the event of acute symptoms, for example if vision is severely impaired after waking up, the affected person should call the emergency services. People who suffer from immunodeficiency or have recently contracted a viral infection are particularly at risk. Diabetes, fungal infections and bacterial diseases are also possible triggers. Anyone who belongs to these risk groups should consult a doctor immediately with the symptoms mentioned. In addition to the family doctor, the ophthalmologist is the right contact person.
Treatment and therapy
In which form the treatment of corneal inflammation takes place, depends essentially on the respective cause of the disease. For example, in the case of infectious inflammation, medications are administered that are specifically adapted to the pathogen identified in the individual case. This guarantees maximum treatment success within the shortest possible time. Typically, antibiotics such as tetracyclines are prescribed in connection with bacteria, while antivirals are used to combat viruses. An infection with fungi should continue to be countered with the administration of antifungals. The treatment is different if the trigger of corneal inflammation is dryness of the eyes associated with reduced lacrimation. In this case, it is advisable to rely on special massages of the eyelid margin and, if necessary, to alleviate the symptoms with the aid of a tear substitute fluid. Furthermore, if corneal inflammation appears merely as a distressing concomitant of an underlying disease, the therapy of this disease is of utmost importance.
Outlook and prognosis
It is very difficult to give an exact outlook and prognosis for a present corneal inflammation, because this clinical picture occurs in different degrees of severity. Another factor that strongly influences the prognosis is the trigger of the inflammation. The earlier an appropriate treatment is initiated, the shorter the duration of the disease or the risk of further complications.Normally, corneal inflammation can be treated very well and effectively, so that a significant improvement can be expected within a few days. In the case of more severe infections, the healing period can take up to two weeks. Medical or drug treatment is necessary in the case of corneal inflammation, otherwise permanent consequential damage can occur. In the worst case, there is a risk of permanent damage to the cornea, with complete blindness in the affected eye. Vision could not be restored even by surgical intervention.
Prevention
The development of corneal inflammation can be counteracted only to a limited extent due to the versatility of its causes. It proves helpful to pay attention to the observance of certain behaviors – such as regular cleaning of contact lenses and their containers, and also the protection of the eyes from direct sunlight. In addition, should typical risk factors be present, an eye examination perceived at regular intervals is also recommended.
Aftercare
Following corneal inflammation, close medical care is important. The patient should consult the physician after a few days so that any complications that may arise can be promptly identified and treated. In the subsequent period, the ophthalmologist should be consulted regularly, especially in the case of chronic or severe inflammation associated with severe discomfort. In the case of severe corneal inflammation, the eye should be checked two to three times a week at the beginning, as there is a high risk of complications. In addition, some rules of conduct should be observed. The affected eye should not be rubbed or pressed around. External stimuli in the form of cold drafts, dust or direct sunlight should also be avoided by protecting the eye with a medical eye patch or other aid. Patients who expose their eyes to greater occupational strain should first take a sick leave. The prescribed medication should continue to be used as directed until the inflammation has completely subsided. If unexpected complaints occur, for example a sudden deterioration in vision or severe pain in the area of the inflammation, a visit to the doctor is recommended. If the discomfort is mild, the next follow-up appointment can be waited for.
What you can do yourself
If the corneal inflammation was caused by an infection with bacteria, viruses or fungi, the patient must pay increased attention to hygiene. Many people regularly grab their faces or rub their eyes. However, these mostly harmless gestures can cause pathogens that are on the hands to enter the eye and trigger or intensify an infection. Those affected should therefore wash their hands thoroughly on a regular basis and check their gestures. Those who use contact lenses should clarify with their doctor whether they may be worn despite keratitis or whether they have to resort to glasses. If the cornea becomes inflamed because the eye produces too little natural tear fluid, artificial tears can be used. In addition, people who suffer from dry eyes and work at computer screens should take regular breaks and blink vigorously, which stimulates tear production. In addition, care should be taken to maintain a sufficiently high level of humidity at the workplace and at home. It often already helps to set up large bowls with water and to ventilate regularly. On longer flights, thermal water sprays from the pharmacy, which are also available in handbag format and are usually allowed in the cabin, can provide relief.
