Posters

A case of persistent filamentary keratitis: differential diagnosis and strategies for treatment

Poster Details

First Author: T. Lalias GREECE

Co Author(s):    E. Kanonidou                    

Abstract Details

Purpose:

Filamentary keratitis is a debilitating manifestation of aqueous tear-deficient dry eye. In chronic cases it can lead to corneal vascularization and scarring. The diagnosis is not always definite as it can be confused with corneal ulcer, microbial or herpetic keratitis.Our purpose is to present a case of persistent filamentary keratitis, the diagnostic dillemas and the proposed ways of treatment.

Setting:

Department of Ophthalmology, 212 Military Hospital of Xanthi, Xanthi, Greece./ Department of Ophthalmology, ‘’Hippokrateion’’ General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

A 48 year old woman presented with foreign body sensation, redness and light sensitivity to the RE. She had these symptoms for two months and she had been treated for conjuctivitis and herpetic keratitis with no benefit. Her ophthalmic and medical history was clear.

Results:

At the slit lamp examination the RE had superficial keratitis with the presence of filaments. The same but milder appearance had the LE, nevertheless the patient had no symptoms from it. Schirmer test and BUT where pathological. The diagnosis was filamentary keratitis and she was treated with intensive lubrication with natural tears, non steroidal anti-inflammatory and corticosteroid drops. In the meantime the filaments were mechanically removed. The patient came back after one week with mild improvement of symptoms. She was additionaly treated with hypertonic saline drops with complete regression of symptoms untill today.

Conclusions:

First line treatment of filamentary keratitis involves intense lubrication of the cornea, anti-inflammatory and corticosteroid drops. Removement of the filaments is crucial and can be achieved either mechanically or with the use of hypertonic saline. The latter draws fluid from the cornea. This promotes adherence of the epithelial cells on the surface to the underlying corneal tissue and hence, prevents formation of new receptor sites for filament formation. Additionaly, therapeutic bandage contact lenses and punctal occlusion can be applied. In any case, judicious use of topical medication should be made in order to avoid toxicity of the cornea.

Financial Disclosure:

NONE