Keratoconjunctivitis: Symptoms, Causes, Treatment

What are the symptoms of keratoconjunctivitis?

Keratoconjunctivitis refers to inflammation of both the cornea (keratitis) and the conjunctiva (conjunctivitis). Symptoms can include:

1. Eye redness: The whites of the eyes may appear pink or red due to inflammation of the conjunctiva.
2. Eye pain or discomfort: Aching, burning, or a feeling of grittiness in the eyes.
3. Excessive tearing or watery eyes: Increased tear production as a response to irritation.
4. Blurred vision: Vision may be affected due to inflammation or changes in tear film quality.
5. Sensitivity to light (photophobia): Discomfort or pain when exposed to bright light.
6. Foreign body sensation: Feeling like there is something in the eye, often described as gritty or scratchy.
7. Discharge: Watery or mucous discharge from the eyes, especially in cases of viral or bacterial keratoconjunctivitis.
8. Eyelid swelling: Swelling of the eyelids due to inflammation.

Symptoms can vary depending on the underlying cause of keratoconjunctivitis, whether it’s viral, bacterial, allergic, or related to another condition. If you suspect keratoconjunctivitis, it’s important to seek evaluation and treatment from an eye care professional for appropriate management.

What are the causes of keratoconjunctivitis?

Keratoconjunctivitis can be caused by various factors, each affecting the cornea (keratitis) and conjunctiva (conjunctivitis) simultaneously. Here are some common causes:

1. Viral Infections: Viruses such as adenovirus (which causes viral conjunctivitis or “pink eye”) can also lead to keratitis, resulting in keratoconjunctivitis.
2. Bacterial Infections: Bacterial infections, such as those caused by Staphylococcus aureus or Streptococcus pneumoniae, can cause both conjunctivitis and keratitis.
3. Allergic Reactions: Allergens like pollen, dust mites, or pet dander can trigger allergic conjunctivitis, which may also affect the cornea in some cases, leading to keratoconjunctivitis.
4. Dry Eye Syndrome: Chronic dryness of the eyes can cause irritation and inflammation of both the cornea and conjunctiva, resulting in keratoconjunctivitis.
5. Contact Lens Wear: Improper use, poor hygiene, or extended wear of contact lenses can increase the risk of microbial keratitis and associated conjunctivitis.
6. Chemical Exposure: Exposure to irritants or chemicals, such as chlorine in swimming pools or household cleaners, can lead to irritation of the eyes and potentially keratoconjunctivitis.
7. Autoimmune Diseases: Conditions like Sjögren’s syndrome or Stevens-Johnson syndrome can cause severe dry eye and inflammation of the cornea and conjunctiva.
8. Exposure to Ultraviolet (UV) Light: Excessive exposure to UV radiation, such as from sunlight or tanning beds, can cause photokeratitis, which is a form of keratoconjunctivitis.
9. Inflammatory Disorders: Conditions like rosacea or blepharitis (inflammation of the eyelids) can contribute to chronic inflammation of the eyes, leading to keratoconjunctivitis.
10. Trauma or Injury: Physical injury to the eye, such as scratches (corneal abrasions), can cause both keratitis and conjunctivitis.

Diagnosis and treatment of keratoconjunctivitis depend on identifying the underlying cause. Prompt evaluation by an eye care professional is important to determine the appropriate treatment to alleviate symptoms and prevent complications.

How is the diagnosis of keratoconjunctivitis made?

The diagnosis of keratoconjunctivitis involves a comprehensive eye examination by a healthcare professional, typically an ophthalmologist or optometrist. Here are the steps involved in diagnosing keratoconjunctivitis:

1. Medical History: The doctor will ask about your symptoms, including any eye pain, redness, discharge, sensitivity to light, or changes in vision. They will also inquire about any recent illnesses, allergies, contact lens use, or exposure to irritants.
2. Visual Acuity Test: This standard eye test measures how well you can see at various distances. It helps assess if there are any vision changes associated with keratoconjunctivitis.
3. Slit Lamp Examination: This specialized microscope with a bright light allows the doctor to examine the structures of the eye in detail, including the cornea and conjunctiva. They will look for signs of inflammation, such as redness, swelling, or discharge.
4. Fluorescein Staining: A dye called fluorescein is applied to the surface of the eye. This dye highlights any damage or abnormalities on the cornea when viewed under a blue light. It helps identify areas of corneal abrasion, ulceration, or other lesions.
5. Schirmer Test: This test measures the production of tears to evaluate for dry eye syndrome, which can be associated with keratoconjunctivitis.
6. Microbial Culture: If there is suspicion of a bacterial, viral, or fungal infection causing keratoconjunctivitis, samples (such as corneal scrapings or conjunctival swabs) may be taken and sent to a laboratory for culture and sensitivity testing.
7. Allergy Testing: If allergic keratoconjunctivitis is suspected, allergy testing may be recommended to identify specific allergens triggering the condition.
8. Other Tests: Depending on the suspected cause, additional tests may be performed, such as testing for autoimmune markers or imaging tests (like optical coherence tomography) to assess the extent of corneal involvement.

The combination of these diagnostic methods helps determine the underlying cause of keratoconjunctivitis and guides appropriate treatment. Early diagnosis is crucial to prevent complications and manage symptoms effectively.

What is the treatment for keratoconjunctivitis?

The treatment for keratoconjunctivitis depends on its underlying cause, which could be viral, bacterial, allergic, or related to other factors. Here are general approaches to treating keratoconjunctivitis:

1. Antibiotic, Antiviral, or Antifungal Medications: If keratoconjunctivitis is caused by a bacterial, viral, or fungal infection, specific medications targeting the responsible organism will be prescribed. These may be in the form of eye drops, ointments, or oral medications.
2. Antihistamines or Mast Cell Stabilizers: For allergic keratoconjunctivitis, medications such as antihistamine eye drops or mast cell stabilizers can help alleviate symptoms by reducing inflammation and allergic reactions.
3. Artificial Tears or Lubricating Eye Drops: Lubricating eye drops (artificial tears) can help relieve dryness and discomfort associated with keratoconjunctivitis, especially in cases of dry eye syndrome or mild irritation.
4. Corticosteroid Eye Drops: In some cases of severe inflammation, corticosteroid eye drops may be prescribed to reduce swelling and inflammation. However, these are typically used cautiously and under close supervision due to potential side effects.
5. Cold Compresses: Applying cold compresses over closed eyelids can help reduce swelling and soothe irritated eyes.
6. Environmental and Lifestyle Changes: Avoiding known allergens, practicing good eye hygiene (especially for contact lens wearers), and protecting the eyes from irritants and UV light can help manage and prevent recurrence of keratoconjunctivitis.
7. Management of Underlying Conditions: Treating underlying conditions such as dry eye syndrome, autoimmune diseases, or blepharitis (eyelid inflammation) is important to control keratoconjunctivitis.
8. Follow-Up Care: Regular follow-up visits with your eye care provider are essential to monitor your response to treatment and adjust the management plan as needed.

In severe cases or when conservative treatments fail, more specialized treatments such as immunosuppressive therapy, surgical intervention, or procedures like amniotic membrane transplantation may be considered. The specific treatment approach will be tailored to your individual condition and symptoms, so it’s important to work closely with your healthcare provider to determine the best course of action.