Introduction:

Filamentary keratitis is a rare and potentially debilitating corneal condition characterized by the formation of filamentous strands on the corneal surface. These strands, composed of degenerated epithelial cells and mucus, adhere to the cornea, leading to irritation, discomfort, and vision disturbances. This article aims to provide a comprehensive overview of filamentary keratitis, including its etiology, clinical features, diagnosis, and management.

Etiology:

The exact cause of filamentary keratitis remains unclear, but several underlying factors have been associated with its development:

• Dry Eye Syndrome: One of the most common associations is with dry eye disease, where reduced tear production or poor tear film quality leads to corneal surface irregularities, providing a substrate for filament formation.
• Corneal Abrasions: Any injury or abrasion to the cornea, such as from contact lenses, may trigger filament formation.
• Neurotrophic Keratopathy: Damage to corneal nerves can lead to reduced corneal sensitivity and tear film instability, contributing to filament development.
• Ocular Surface Inflammation: Conditions like blepharitis, conjunctivitis, and meibomian gland dysfunction can lead to chronic inflammation, which may facilitate filament formation.

Clinical Features:

The hallmark sign of filamentary keratitis is the presence of whitish or grayish strands adhering to the cornea's surface. Other common clinical features include:

• Foreign Body Sensation: Patients often complain of a persistent feeling of something in the eye.
• Photophobia: Increased sensitivity to light is frequently observed.
• Redness and Irritation: The eye may appear red, and there can be persistent irritation and discomfort.
• Decreased Vision: In more severe cases, filamentary keratitis can cause blurred or decreased vision.

Diagnosis:

Diagnosing filamentary keratitis involves a comprehensive eye examination, including slit-lamp biomicroscopy to visualize the characteristic filaments on the cornea's surface. Special staining with rose bengal or lissamine green dyes may help highlight the filaments and assess the extent of ocular surface damage.

Management:

The management of filamentary keratitis focuses on addressing the underlying causes and providing symptomatic relief:

• Artificial Tears: Preservative-free lubricating eye drops can help improve tear film stability and reduce irritation.
• Topical Medications: Anti-inflammatory eye drops or ointments may be prescribed to manage ocular surface inflammation.
• Eyelid Hygiene: Proper lid hygiene, warm compresses, and lid scrubs can aid in managing blepharitis and meibomian gland dysfunction.
• Moisture Chamber Glasses: For severe cases, moisture chamber glasses can be worn to protect the ocular surface and retain moisture.
• Contact Lens Management: If contact lens wear is contributing to the condition, modifying or discontinuing lens use may be necessary.
• Punctal Plugs: In cases of severe dry eye, punctal plugs can be inserted to increase tear retention.
• Amniotic Membrane Transplantation: In refractory cases, amniotic membrane transplantation can aid in corneal healing and reduce filament formation.

Conclusion:

Filamentary keratitis is an uncommon yet distressing corneal condition characterized by the presence of filamentous strands on the cornea's surface. Understanding its underlying etiology, recognizing the clinical features, and providing appropriate management are essential to alleviate symptoms and preserve ocular health.

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