Keratitis may be epithelial, stromal, peripheral, or, in rare cases, endothelial.
Interstitial keratitis may occur in the first decade of life secondary to congenital syphilis (discussed in Chapter 28). The keratitis presents as a rapidly progressive corneal edema followed by abnormal vascularization in the deep stroma adjacent to Descemet membrane. Intense vascularization may give the cornea a salmon-pink color—hence the term salmon patch. Blood flow through these vessels gradually ceases over several weeks to several months, leaving empty “ghost” vessels in the corneal stroma. Immune-mediated uveitis, arthritis, and hearing loss may also develop and may recur even after treatment of syphilis. Immunosuppression may be necessary to diminish sequelae.
Herpes simplex infection
Eye involvement in congenital herpes simplex virus (HSV) infection can include conjunctivitis, keratitis, retinochoroiditis, and cataracts. Congenital HSV infection is discussed in Chapter 28.
Punctate epithelial keratitis is most often seen after adenoviral infection; it is due to subepithelial immune complex deposition. See BCSC Section 8, External Disease and Cornea, for further discussion.
Punctate epithelial erosions are most commonly seen in patients with lagophthalmos or dry eye disease. Peripheral (marginal) keratitis is usually associated with blepharokerato-conjunctivitis secondary to meibomian gland disease.
Thygeson superficial punctate keratitis
The etiology of Thygeson superficial punctate keratitis is unclear, but it is thought to be immune-mediated. It can occur in children and presents with tearing, photophobia, and reduced vision. The condition is bilateral but often asymmetric. Characteristic features include slightly elevated gray corneal epithelial lesions with negative staining. It is treated with mild corticosteroids (eg, fluorometholone 0.1%) or topical cyclosporine 0.05%.
This syndrome is a rare vasculitis that presents with ocular, audiovestibular, and systemic features. Interstitial keratitis, uveitis, conjunctivitis, episcleritis, or a combination of these features may be seen.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.