Interstitial keratitis (IK) is corneal scarring due to chronic inflammation of the corneal stroma. Interstitial means space between cells i.e. corneal stroma which lies between the epithelium and the endothelium. Keratitis means corneal inflammation.
Acutely, early symptoms include a painful, photophobic, red watery eye. This is due to active corneal inflammation resulting in vascular invasion and stromal necrosis which can be diffuse or localized. This causes the pinkish discoloration of what was a clear transparent normal corneal tissue (called Salmon patch of Hutchinson).[citation needed]
Such vascularization is likely to result in blurring of vision secondary to corneal stromal scarring, the presence of ghost vessels, and thinning of the cornea, especially if it involves the visual axis.[citation needed]
By far the most common cause of IK is syphilitic disease. However, there are two possible causes of the corneal inflammatory response: an infection and/or an immunological response, such as a hypersensitivity type reaction, or (rarely) Cogan syndrome.[1] Infectious causes include syphilis (commonest), followed by other bacterial infections (TB, Leprosy and Lyme disease) and parasitic infections (Acanthamoeba, Onchocerciasis or river blindness, Leishmaniasis, Trypanosoma cruzi or Chagas disease, Trypanosoma brucei or African sleeping sickness and microsporidia)[2]
The corneal scarring is the end result of the initial invasion of blood vessels into the corneal stroma as part of the inflammatory response. Since normal corneal tissue should be avascular (no blood vessel) and therefore clear to allow light to pass, the presence of blood vessel and the infiltration of cells as part of the inflammatory process results in scarring or hazing of the cornea.[3]
A positive VDRL of Treponema pallidum immobilization test confirms diagnosis of luetic(syphilitic) interstitial keratitis[citation needed]
La causa subyacente debe tratarse lo antes posible para detener el proceso de la enfermedad. Se pueden usar gotas de corticosteroides para minimizar las cicatrices en la córnea junto con una cobertura antibiótica . Sin embargo, no se pueden evitar las cicatrices residuales, que pueden provocar una discapacidad visual a largo plazo y el trasplante de córnea no es adecuado debido a la alta tasa de rechazo de la vascularización corneal. [4]
Infección ocular previa de larga duración que posiblemente durante la infancia recordó haber sido tratada con antibióticos y/o hospitalizada durante un largo período de tiempo. [ cita necesaria ]