Keratoconjunctivitis: symptoms, diagnosis and treatment of this inflammation of the eye

By Cristiano Antonino On Mar 22, 2023

Keratoconjunctivitis can be defined as a disease that causes severe inflammation in the eye

Specifically, this disease can simultaneously lead to keratitis and conjunctivitis, therefore to inflammation of the cornea and conjunctiva, with potentially severe consequences for the health of our eyes.

The symptoms of keratoconjunctivitis can be many, different from each other depending on the type of inflammation in progress

Among the most frequent are hyperlacrimation, redness or hyperemia, enlarged lymph nodes and many other symptoms.

These disorders can also lead to difficulty performing everyday tasks, such as reading or driving a car.

The causes of keratoconjunctivitis can be very different even if the clinical manifestations are quite similar.

Given the fact that there are different types of keratoconjunctivitis, it is difficult to get an overview of the number of patients affected by this pathology.

For example, the most affected by atopic keratoconjunctivitis are children under 4 years old or adults between 20 and 50 years old.

Furthermore, about 95% of patients have other relatives with atopic ocular or skin problems.

Today there are many treatments for keratoconjunctivitis, differing in the type of pathology, inflammation and etiological agent.

Types of keratoconjunctivitis

There are several types of keratoconjunctivitis that differ in symptoms, causes, and many other factors.

Among the best known are:

keratoconjunctivitis sicca, which is the most common and the one most often referred to when using the term “keratoconjunctivitis”. This inflammation mostly affects the elderly and middle-aged. The complication of this type of inflammation can lead to the formation of corneal ulcers and can be consequent to Sjögren’s syndrome;
epidemic keratoconjunctivitis, which has an infectious cause, is usually caused by an adenovirus. Often this inflammation is also combined with tonsillitis, pneumonia and colds. Among the first symptoms there may be hyperlacrimation, redness and inflammation of the preauricular lymph nodes;
Vernal keratoconjunctivitis is a very frequent, seasonal, allergic type of eye inflammation. Specifically, this inflammation occurs in spring and decreases until it disappears in autumn and winter. It is typical for those who suffer from allergies, especially to pollen or dust. It can be linked to fever, asthma and eczema. The eyes are red, they can burn, itching and photophobia are perceived. In order to experience immediate relief and avoid complications, cortisone and antihistamine eye drops are used in this case.

The symptoms of keratoconjunctivitis sicca can be many

Among the most popular are:

pain and burning in the eyes
red eyes and ocular hyperemia
hypersensitivity to light and photophobia
difficulty focusing and blurred vision

A symptom of keratoconjunctivitis sicca can also be the appearance of mucus.

This substance in or around the eye can lead to significant discomfort, such as blurred vision.

The altered tear film can produce very severe consequences for the corneal surface such as corneal ulcers, which in the most serious cases can even lead to corneal perforation.

In these cases there is also a predisposition to superinfection of the damaged and inflamed eye.

More common symptoms of keratoconjunctivitis sicca can also be tiredness and eyestrain.

Also, on rainy or foggy days, symptoms can be relieved due to the high humidity.

Factors such as dehydration, dry and dusty environments and prolonged visual efforts can lead to a greater likelihood of the typical symptoms of this inflammation appearing.

In this pathology there is important dryness of the conjunctiva, therefore also a lacrimation deficit.

Tears may foam at the lid margins and lead to chronic drying which may cause possible keratinization of the ocular surface.

The causes of keratoconjunctivitis can be different and also deriving from various ongoing pathologies

One cause of keratoconjunctivitis sicca may be Sjögren’s syndrome.

This disease is characterized by an abnormality of the immune system.

This autoimmune condition can affect various exocrine glands, not only the eye, but also the oral cavity, organs and tissues causing inflammation in these tissues.

There are several factors that can lead to this autoimmune disease: the genetic one and the viral one.

A cause of keratoconjunctivitis sicca is also the presence of forms of allergic conjunctivitis.

Inflammation of the conjunctiva due to allergens such as contact lenses, dust, pollen and many others can lead to a form of keratoconjunctivitis of this type.

Blepharitis can be among the causes of Keratoconjunctivitis

In fact, the inflammation of the eyelids that leads to various scales and ulcers can also spread to the eye, reaching the conjunctiva.

The other pathologies that can be among the causes of keratoconjunctivitis can be: rheumatoid arthritis, systemic lupus erythematosus, damage to the lacrimal gland, trachoma or HIV, therefore diffuse infiltrative lymphocytosis syndrome.

Differences with epidemic keratoconjunctivitis

There are many differences between the forms of sicca and epidemic keratoconjunctivitis.

Of course, the causes of these two pathologies are completely different.

In fact, in the case of Adenovirus keratoconjunctivitis it is an inflammation of the cornea and conjunctiva caused by an infection.

The pathogen responsible for this inflammation is the Adenovirus, which gives its name to the disease.

Pinpointing the cause of keratoconjunctivitis is key to understanding the differences between symptoms.

In fact, Adenovirus is also responsible for many viral infections that can affect the respiratory tract.

For this reason, in addition to the symptoms of epidemic keratoconjunctivitis, there may be concomitant tonsillitis, pneumonia, colds and pharyngitis.

Symptoms in this case can be:

eye redness
acute conjunctivitis
hypertearing
inflammation of the cornea
conjunctival edema
flu symptoms such as fever and general malaise
vomit
nausea
diarrhea

The treatments for keratoconjunctivitis can be different: analgesic eye drops are usually applied, but also cold compresses on the eyelids, corticosteroid-based eye drops and eye hygiene measures.

Diagnosis

To diagnose keratoconjunctivitis, you must first request an initial visit to your general practitioner.

Thanks to a quick medical history, in fact, he will eventually be able to recommend a specialist visit if a more specific approach to the problem is necessary.

The ophthalmologist will therefore carry out an evaluation to identify the cause of the keratoconjunctivitis.

If you suspect a form of keratoconjunctivitis sicca, the specialist may use some specific tests such as the Schirmer test and tear film breakup time tests.

The first exam, the Schirmer test, is important to verify that tear production is normal.

To do this, the closed eye is swabbed and a strip of absorbent paper is placed.

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From the results obtained from this test, it is possible to understand the level of lacrimation in the eye and possibly diagnose a lacrimation deficit.

The second exam, or the tear film breakup test (BUT), involves the application of fluorescein inside the conjunctival sac.

In this way the doctor will be able to verify the permanence of the veil of tears (“film”) on the surface of the cornea.

After these two tests it is possible to diagnose keratoconjunctivitis sicca and therefore formulate an adequate treatment according to the patient’s needs and symptoms.

The usual ophthalmological examination with objective examination of the anterior segment of the eyes, together with a careful medical history, will instead allow the diagnosis of the epidemic and vernal forms of keratoconjunctivitis.

Treatments for keratoconjunctivitis depend on the type of inflammation and the cause

They may be different from each other if we are faced with atopic, gigantopapillary, dry, vernal or epidemic keratoconjunctivitis.

In the case of bacterial infections, for example, antibiotics may be prescribed, in the form of eye drops, to be applied in order to eliminate the infection. After the course of antibiotics the inflammation should subside until the symptoms disappear.

In the case of forms of keratoconjunctivitis due to allergies, the patient could be given antihistamine eye drops, in order to relieve the symptoms, reduce burning and itching.

In these cases, treatments can help overcome the allergic reaction phase, for example to pollen, mites and contact lenses, and to avoid permanent damage to the corneal surface.

In the most serious and complex cases, cortisone drugs can also be prescribed, thanks to their anti-inflammatory action that can also act on severe inflammation.

As a remedy for keratoconjunctivitis sicca there are artificial tears

These products are very useful and there are different types in order to integrate the deficient component of the tear film.

For this reason it is essential to consult a specialized doctor to evaluate the degree of viscosity of artificial tears and the most suitable type to integrate your tear film.

It will be possible to keep the eyes well hydrated and prevent the unpleasant symptoms of keratoconjunctivitis.

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