Cornea Keratoconjunctivitis

Keratoconjunctivitis sicca Dryness of conjunctiva and cornea a component of Sjogren s syndrome. 

Infections Treatment of superficial ocular infections involving the conjunctiva or cornea (eg, conjunctivitis, keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, blepharoconjunctivitis, acute meibomianitis, dacryocystitis) caused by strains of microorganisms susceptible to antibiotics. 

Efficacy In other conditions The clinical efficacy in the treatment of stromal keratitis and uveitis caused by herpes simplex or ophthalmic infections caused by vaccinia virus and adenovirus, or in the prophylaxis of herpes simplex virus keratoconjunctivitis and epithelial keratitis has not been established by well-controlled clinical trials. Not effective against bacterial, fungal, or chlamydial infections of the cornea or trophic lesions. 

Patients with severe keratoconjunctivitis sicca are at definite risk of this complication, and the addition of phosphate-containing eye-drops tilted the precariously balanced situation toward precipitation of calcium in the cornea and bandage contact lens. Acetate-containing rather than phosphate-containing glucocorticoid eye drops may be a safer alternative in patients with such predisposing factors. 

Laibovitz RA, Solch S, Andriano K, et al. Pilot trial of cyclosporine 1% ophthalmic ointment in the treatment of keratoconjunctivitis sicca. Cornea 1993 12 315-323. 

Figure l6-9 Rose bengal staining in patient with keratoconjunctivitis sicca (arrows). Note the typical triangular shape and location in the area of eyelid gap of the cornea and conjunctiva. (Courtesy Mark Williams, O.D.)... 

Associated conditions may include papillary conjunctivitis keratoconjunctivitis sicca (KGS), present in as many as 50% of patients superficial punctate keratitis (SPK), affecting predominantly the inferior quadrant of the cornea ... 

Takano Y, Fukagawa K, Miyake-Kashima M, et al. Dramatic healing of an allergic corneal ulcer persistent for 6 months by amniotic membrane patching in a patient with atopic keratoconjunctivitis. Cornea 2004 23 723-725. 

Chryseosis corneae (deposition of gold crystals in the cornea) occurs rarely in patients treated with a cumulative dose of up to 500 mg of gold, but they occur in nearly all patients who have received 1500 mg or more (28). Deposition of gold as such has no chnical consequences. Gold can occasionally cause a keratitis or keratoconjunctivitis, but these are usually associated with skin involvement and are not a consequence of gold deposits in the cornea. 

Chlortetracycline ointment (1%) is indicated for conjunctivitis or keratoconjunctivitis where Chlamydia or Mycoplasma spp. are the suspected primary pathogens. Topical chloramphenicol is reported to be effective against clostridial infections of the cornea (Rebhun et al 1999). 

Ocular manifestations include keratoconjunctivitis sicca and inflammation of the sclera, episclera, and cornea. Atrophy of the lacrimal duct may result in a decrease in tear formation, causing dry and itchy eyes, termed keratoconjunctivitis sicca. When this is observed in association with rheumatoid arthritis, it is referred to as Sjogren s syndrome. Artificial tears may be used to relieve symptoms. Inflammation of the superficial layers of the sclera (episcleritis) is generally self-limiting. Involvement of deeper tissues (scleritis) usually results in a more serious, painful, and chronic inflammation. Rheumatoid nodules may develop on the sclera. 

Nutritional vitamin A deficiency causes xerophthalmia, a progressive disease characterized by night blindness, xerosis (dryness), and keratomalacia (comeal thinning), which may lead to perforation xerophthalmia may be reversed with vitamin A therapy. However, rapid, irreversible blindness ensues once the cornea perforates. Vitamin A also is involved in epithelial differentiation and may have some role in corneal epithelial wound healing. There is no evidence to support using topical vitamin A for keratoconjunctivitis sicca in the absence of a nutritional deficiency. 

Keratoconjunctivitis Condition in which vesicles appear in the cornea and eyelids. 

Herpetic keratoconjuctivitis Inflammation of the cornea caused by herpes virus. The epidemic form of keratoconjunctivitis is usually caused by adenoviruses. 

Chen, W. Zhao, K. Li, X. Yoshitomi, T. Keratoconjunctivitis sicca modifies epithelial stem cell proliferation kinetics in conjunctiva. Cornea 2007,26,1101-1106. 

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