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Keritis (Corneal Inflammation)

What is Keritis (Corneal Inflammation)?

Keritis, more commonly called corneal inflammation, refers to swelling, redness, and irritation of the cornea—the clear, dome‑shaped front surface of the eye that helps focus light. When the cornea becomes inflamed, its normally transparent structure can become hazy, leading to visual changes and discomfort. Keritis is not a disease in itself but a sign that an underlying problem is affecting the eye.

The condition can range from a mild, self‑limiting irritation to a severe, sight‑threatening emergency. Prompt recognition and treatment are essential because the cornea has limited blood supply; it relies on the tear film and surrounding tissues for nutrients and immune defense. Delayed care can result in scarring, permanent vision loss, or infection spreading to the inside of the eye (endophthalmitis).

Sources: Mayo Clinic, American Academy of Ophthalmology (AAO), National Eye Institute (NEI).

Common Causes

Numerous factors can trigger keritis. Below are the most frequently encountered causes:

• Infectious keratitis – Bacterial, viral (herpes simplex, adenovirus), fungal, or parasitic (Acanthamoeba) organisms.
• Contact‑lens wear – Improper hygiene, overnight wear, or using lenses past their replacement schedule.
• Trauma – Scratches (corneal abrasions), foreign bodies, or chemical burns.
• Dry eye syndrome – Insufficient tear production or poor tear quality leading to epithelial breakdown.
• Exposure to ultraviolet (UV) light – “Snow blindness” or photokeratitis from intense UV exposure.
• Autoimmune disorders – Rheumatoid arthritis, Sjögren’s syndrome, or Stevens‑Johnson syndrome causing inflammatory infiltrates.
• Allergic eye disease – Vernal keratoconjunctivitis or atopic keratoconjunctivitis.
• Medication toxicity – Topical eye drops (e.g., corticosteroids, anesthetics) used in excess.
• Refractive surgery complications – LASIK or PRK can transiently inflame the cornea.
• Systemic infections – Herpes zoster ophthalmicus or syphilis affecting the cornea.

Associated Symptoms

While each cause may produce a slightly different pattern, keritis commonly presents with the following signs and symptoms:

• Eye pain or a gritty sensation (“like sand in the eye”) – often worsens with blinking.
• Redness, especially around the cornea (a circumcorneal injection).
• Blurred or decreased vision, sometimes with halos around lights.
• Photophobia – increased sensitivity to light.
• Tearing or watery discharge.
• Sticky or mucoid discharge (more common with bacterial infection).
• Foreign‑body sensation or feeling of “something in the eye.”
• Swelling of the eyelids (eyelid edema).
• In severe cases, a visible ulcer or white spot on the cornea.

When to See a Doctor

Because the cornea is essential for clear vision, any new or worsening eye discomfort warrants prompt evaluation. Seek professional care if you notice:

• Severe pain, especially if it is sudden or worsening.
• Vision loss or “double vision” that does not improve.
• Rapidly increasing redness or swelling.
• Discharge that is thick, yellow/green, or foul‑smelling (possible bacterial infection).
• History of recent eye trauma, chemical exposure, or a corneal scratch.
• Contact‑lens wearers experiencing redness, pain, or vision changes—especially if lenses have been worn overnight.
• Symptoms persisting longer than 24–48 hours despite home care.

Early evaluation reduces the risk of complications such as corneal scarring or perforation.

Diagnosis

Eye specialists (ophthalmologists or optometrists) use a combination of history‑taking, visual‑acuity testing, and specialized tools to confirm keritis and determine its cause.

Clinical Examination

• Slit‑lamp biomicroscopy – Provides a magnified, illuminated view of the cornea to identify infiltrates, ulcers, or epithelial defects.
• Fluorescein staining – A drop of fluorescein dye highlights breaks in the corneal epithelium under a blue light (Wood’s lamp).
• Visual acuity testing – Determines how much vision is affected.
• Intra‑ocular pressure (IOP) measurement – Helps rule out secondary glaucoma.

Laboratory Tests (if infection suspected)

• Corneal scrapings for Gram stain, culture, and sensitivity.
• Polymerase chain reaction (PCR) for viral DNA (e.g., HSV, adenovirus).
• Fungal stains (KOH) or cultures for mold/yeast.
• Confocal microscopy – especially useful for Acanthamoeba detection.

Imaging (rarely needed)

• Anterior segment optical coherence tomography (AS‑OCT) – Provides cross‑sectional images of corneal layers.
• Ultrasound biomicroscopy – Helps assess deep stromal involvement.

Treatment Options

Management depends on the underlying cause, severity, and risk of complications.

General Measures (all patients)

• Discontinue contact lenses immediately and do not reuse them.
• Cold compresses – Reduce pain and photophobia.
• Lubricating (preservative‑free) artificial tears – Keep the ocular surface moist.
• Avoid rubbing the eye and protect it from wind or bright light (wear sunglasses).

Medication‑Based Therapies

• Antibiotic eye drops or ointments for bacterial keratitis (e.g., moxifloxacin, fortified cefazolin/amikacin). Duration: 7‑14 days or as directed.
• Antiviral agents for herpes simplex keratitis – topical trifluridine, ganciclovir, or oral acyclovir/valacyclovir.
• Antifungal drops such as natamycin 5% (first‑line for filamentous fungi) or voriconazole.
• Anti‑Acanthamoeba therapy – Combination of polyhexamethylene biguanide (PHMB) and chlorhexidine, plus propamidine isethionate.
• Corticosteroid eye drops – Used cautiously after infection is controlled or for immune‑mediated keratitis (e.g., autoimmune, allergic). Improper use can worsen infection.
• Pain control – Oral NSAIDs, cycloplegic drops (e.g., homatropine) to reduce ciliary spasm, or in severe cases, short‑acting oral opioids under physician supervision.

Surgical Interventions (for advanced cases)

• Therapeutic corneal debridement – Removal of necrotic tissue to promote healing.
• Corneal collagen cross‑linking (CXL) – May stabilize progressive keratoconus‑related keratitis.
• Penetrating or lamellar keratoplasty – Corneal transplant for irreversible scarring or perforation.
• Amniotic membrane graft – Supports epithelial regeneration in severe ulcerative keratitis.

Follow‑up

Most cases require re‑evaluation within 24–48 hours to ensure the infection is responding to therapy and to adjust medication based on culture results.

Prevention Tips

• Proper contact‑lens hygiene – Wash hands, use fresh solution nightly, replace lenses per schedule, and avoid overnight wear unless approved.
• Protect eyes from trauma – Wear safety goggles during sports, home repairs, or laboratory work.
• Use UV‑blocking sunglasses – Prevent photokeratitis when outdoors, especially at high altitudes or reflective surfaces (snow, water).
• Maintain ocular surface health – Treat dry eye with lubricating drops, warm compresses, or prescription therapies (e.g., cyclosporine).
• Avoid sharing eye cosmetics or drops – Reduces bacterial transfer.
• Promptly treat eyelid or conjunctival infections – Prevent spread to the cornea.
• Stay current on vaccinations – Herpes zoster vaccine reduces risk of ocular shingles.
• Regular eye exams – Particularly for contact‑lens wearers, diabetics, or patients with autoimmune disease.

Emergency Warning Signs

Key Take‑aways

Keritis signals inflammation of the cornea and can result from infections, contact‑lens misuse, trauma, dry eye, or systemic disease. Early identification, targeted therapy, and diligent follow‑up are essential to preserve vision. Maintaining good eye hygiene, protecting the eyes from UV light and injury, and obtaining prompt medical attention when symptoms arise are the best strategies to prevent complications.

References:

• American Academy of Ophthalmology. “Keratitis.” AAO.org. Accessed June 2026.
• Mayo Clinic. “Corneal ulcer.” MayoClinic.org. Accessed June 2026.
• National Eye Institute. “Infectious keratitis.” NEI.gov. Accessed June 2026.
• Cleveland Clinic. “Contact lens‑related eye infections.” ClevelandClinic.org. Accessed June 2026.
• World Health Organization. “Prevention of blindness: Guidelines for ocular health.” WHO.int. 2023.

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