Keratoconjunctivitis

Definition

Keratoconjunctivitis is a pathological condition characterized by simultaneous inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis).
There are different sub-categories of keratoconjunctivitis, essentially distinguished on the basis of the causative agent and the symptoms with which they occur.
The most common forms of corneal and conjunctival inflammation are:

• Keratoconjunctivitis sicca (or dry eye syndrome)
• Epidemic keratoconjunctivitis (from Adenovirus)
• Vernal (or vernal) keratoconjunctivitis

Dry keratoconjunctivitis

Typical of the elderly and middle-aged women, keratoconjunctivitis sicca is a common cause of ocular irritation, which originates in all conditions characterized by an alteration of the lacrimal secretory processes.

SYMPTOMS

Also known by the expression of dry eye syndrome, keratoconjunctivitis sicca causes ocular pain and burning, often associated with ocular hyperaemia (red eyes), photophobia (light intolerance), blurred vision and difficulty wearing contact lenses.
In some affected patients, the appearance of stringy mucus in or around the eye is also observed. In severe cases, keratoconjunctivitis sicca can degenerate up to the formation of corneal ulcers: in such situations, the affected patient risks corneal perforation and extensive ocular superinfections.

For further information: Symptoms Dry eye syndrome

CAUSES

The typical dry eye that accompanies this form of keratoconjunctivitis can be associated with serious diseases such as Sjögren's syndrome *, or represent the complication of allergic conjunctivitis * and blepharitis *. Even some unsuitable behavioral habits can constitute possible risk factors for keratoconjunctivitis sicca: in some patients, in fact, the typical symptoms of dry eye syndrome occur precisely because of a low ambient humidity. For this reason, it is necessary to use with moderation and caution air conditioners and convectors.

* Glossary

• Sjögren's syndrome: complex autoimmune disorder that is distinguished by the destruction of the lacrimal glands and other exocrine glands
• Allergic conjunctivitis: inflammation of the conjunctiva induced by an allergen (e.g. pollen, contact lenses, etc.)
• Blepharitis: generic inflammation of the eyelid

THERAPY

Treatment for keratitis sicca depends on the nature of the inflammation. When the cause lies in bacterial infections (caused for example by streptococcus), the most suitable drugs are topical antibiotics, to be instilled in the eye in the form of eye drops. If keratoconjunctivitis sicca is related to allergies, antihistamine eye drops can remove symptoms such as ocular burning and itching.
When dry eye is simply due to low ambient humidity, artificial tears can undoubtedly improve symptoms: in this case, the use of a room humidifier is recommended.

Epidemic keratoconjunctivitis

CAUSES

This form of corneal and conjunctival inflammation is mainly caused by an infection sustained by Adenovirus, the same pathogens involved in most viral infections of the respiratory tract (eg tonsillitis, colds, pneumonia and pharyngitis).

SYMPTOMS

Adenovirus keratoconjunctivitis begins suddenly with characteristic symptoms, such as:

• Acute follicular conjunctivitis
• Hyperlacrimation
• Strong eye redness
• Enlargement of the preauricular lymph nodes
• Inflammation of the cornea (keratitis)
• Chemosis (conjunctival edema)

Viral keratoconjunctivitis can be preceded by typically flu-like symptoms, such as fever, general malaise, nausea, vomiting, and diarrhea.

Although the characteristic symptoms are rather annoying, sometimes disabling, epidemic keratoconjunctivitis tends to regress spontaneously in 2-3 weeks.

THERAPY

Treatment for epidemic keratoconjunctivitis is generally symptomatic, i.e. aimed exclusively at treating the symptoms. Artificial tears and analgesic eye drops are particularly suitable for relieving symptoms; even cold packs to be applied directly to the eyelids can bring immediate relief and promote ocular decongestion.
In severe cases, the doctor may prescribe antiviral eye drops or ophthalmic ointments. Topical corticosteroids are reserved for cases of extreme severity; it is recommended to avoid self-treatment and to always seek medical advice before taking any type of drug.

Vernal keratoconjunctivitis

The so-called "vernal" keratoconjunctivitis is a type of "corneal and conjunctival inflammation that recurs with a" seasonal incidence. Literally, "vernal" means spring, a term used to indicate the moment of onset of symptoms (not surprisingly, this type of inflammation is also known as vernal keratoconjunctivitis).

CAUSES

Vernal keratoconjunctivitis is an allergic disorder that often occurs in patients with atopic diseases such as asthma, hay fever and eczema.

SYMPTOMS

Being allergic in nature, spring keratoconjunctivitis manifests itself with typical symptoms, such as tearing, burning, perception of a foreign body in the eye, photophobia, ocular itching and red eyes. In some cases, this disorder can favor the appearance of painful corneal ulcers. .
The symptoms begin before the arrival of spring and are accentuated during the summer period, and then slowly regress in the autumn and winter months.
Eye inflammation is aggravated by dust, smoke, smog and wind.

THERAPY

Antihistamine treatment for vernal keratoconjunctivitis is essential to control symptoms and prevent flare-ups of the disorder. Some patients resort to the topical application of cortisone eye drops, capable of determining a powerful anti-inflammatory action on the cornea and conjunctiva. Sometimes analgesic eye drops are sufficient to calm the discomfort and burning in the eyes of medium-moderate entity.

Other types of keratoconjunctivitis

In addition to the variants of keratoconjunctivitis just described, there are other forms of corneal and conjunctival inflammation, which however tend to occur less frequently:

• ATOPIC KERATOCONJUNCTIVITIS: fortunately rare, this type of conjunctival and corneal inflammation tends to occur mainly in young adults. Although the cause is still an unresolved question, a certain correlation has been observed between atopic keratoconjunctivitis and some disorders, such as in particular: eczema , asthma and atopic dermatitis. The clinical picture of atopic conjunctivitis is characterized by the appearance of symptoms such as inflammation of the cornea and conjunctiva, itching, profuse lacrimation, photophobia, impaired vision, burning and mucous and stringy ocular secretions. the symptoms with which this form of keratoconjunctivitis occurs are common to numerous other forms of ocular inflammation: for this reason, the diagnostic assessment - rather complex - is essential. The most suitable drugs to reduce the evident inflammation are corticosteroids topicals, which must still be used with mo deration and common sense. In the presence of corneal lesions, the application of ophthalmic ointments with a re-epithelizing action (eg prepared with hyaluronic acid) is recommended.
• GIGANTOPAPILLARY CHERTOCONJUNCTIVITIS: This is a typical disorder of contact lens wearers. In sensitive subjects, frequent use of contact lenses or incorrect application of the same can cause eye inflammation, which results in keratoconjunctivitis. Patients with asthma, hay fever or who have a certain sensitivity to allergens of animal origin also have a rather high risk of developing gigantopapillary keratoconjunctivitis. The disorder manifests itself with ocular redness, conjunctival and corneal irritation, itching and blurred vision. In some cases, this disease can cause corneal ulcers. The first precaution to consider in the presence of gigantopapillary keratoconjunctivitis is to replace the contact lenses with prescription glasses to avoid further injuring the conjunctiva and cornea.