Punctate keratitis: Causes, Symptoms, and Treatment

punctate keratitis

Superficial punctate keratitis (SPK) can be described as the most common manifestation of Thygeson’s Disease in which the top-most layers of the cornea are impaired.

Ophthalmologists may notice small white opacities beneath the cornea’s surface with a distinctive “negative fluorescein staining” pattern.

The most common symptoms are recurrent burning and tearing, sensitivity to light, and a foreign object’s sensation within their eyes. Sometimes, the symptoms can be highly severe, despite showing no signs on a slit lamp examination.

These symptoms are typically self-limiting. However, a mild topical steroid may be prescribed when the symptoms are severe.

Things you need to be aware of regarding the keratitis condition.

  • “Keratitis” is the name used in medical terms used to describe inflammation of the cornea.
  • Keratitis is a condition that has multiple causes, which include dry eyes, infection conditions of the eyelids injuries, chemical and physical and medical conditions that cause it.
  • Signs and symptoms of Keratitis are
    • eye discomfort,
    • blurred vision
    • photophobia,
    • tears and
    • Eye redness.
  • Keratitis is a condition that can be confirmed by using a light source called a slit lamp.
  • If keratitis is treated correctly and promptly it is treated promptly; permanent eye damage is typically avoided.

What is Keratitis?

The medical name is Keratitis. It stands used to describe cornea inflammation. It is the cornea, a dome-shaped opening that is located in the face of the eye.

It is possible to see the pupil and the iris through the cornea, which is usually straightforward when looking into the eyes. This cornea bends light beams because of its curving shape.

It accounts for about two-thirds of an eye’s optical power, while the lens makes up the other third. The fragile tear film is located between the cornea’s front and the rest of our surroundings.

The cornea measures about 0.5 millimeters thick. The cornea’s back is submerged in the aqueous liquid that covers the chamber in the front of your eye.

The cornea measures the size of around 13 millimeters ( 1/2 inch), and when combined, the sclera (the white portion that is the white part of your eye) makes up the whole outer layer that covers the eyes.

Keratitis Symptoms


Sensitivity to light refers to the inability to accept light. It is medically referred to as photophobia. If you are sensitive to light, any light source (sunlight or fluorescent light incandescent light) can cause discomfort.

Photophobia usually causes the need to close or squint the eyes and headaches, nausea, headaches, and other signs that may be related to photophobia. Symptoms may be worse when exposed to bright lighting.

Eyes with light colors are more likely to experience sensitivity towards bright lights than people with darker-colored eyes. Sensitivity to light can result from a range of eye conditions (such as iritis and uveitis, and Keratitis) and diseases that affect the whole body.

Migraine headache is the most common trigger of photophobia, with most migraine sufferers expressing the feeling of being sensitive to light.

What are the reasons for the keratitis?

Keratitis is the condition of the eyes where the cornea is inflamed, could have many causes. Many kinds of eye infections, dry eyes, blemishes of the eyelids, injuries, and a wide range of medical conditions can cause keratitis. Keratitis can result from unidentified causes.

Risk factors that can cause keratitis?

Risk factors that can contribute to developing keratitis are any disruption or break in the cornea’s surface (epithelium) of the cornea.

Contact lenses can increase the chance of developing keratitis. It is especially true in the case of poor hygiene, and the incorrect solutions are employed to clean and store the lenses, or contact lenses are misused or when there is a constant irritation.

A decline in the quantity/quality of tears can lead the eye to develop keratitis.

Illnesses like AIDS cause the impairment of the immune system, and the consumption of medicines like corticosteroids as eye drops or in the form of systemically administered chemotherapy can increase the chance of developing keratitis.

What are the different kinds of Keratitis?

Keratitis is classified based on location, severity, and cause.

If keratitis only affects the cornea’s surface (epithelial) layers, it’s known as superficial corneal keratitis. If it is affecting the deeper levels of the cornea (the corneal stroma), this is known as interstitial or stromal Keratitis.

It can affect the central part of the cornea, the peripheral portion of the cornea (that part closest to the sclera), or both. Keratitis may affect just one or both eyes.

Keratitis could be mild or moderate and can be accompanied by inflammation in other parts of the eyes.

Keratoconjunctivitis means inflammation of both the cornea and conjunctiva. Kerato-uveitis refers to inflammation of the cornea and the uveal tract that comprises the ciliary body, the iris, and the choroid.

Keratitis could be chronic or acute. It can occur just now and then in the eye or become persistent. It could be restricted in its effect on the look or progressing in its destruction. It could affect one or both eyes (unilateral) and both of them (bilateral).

Keratitis has many causes and may cause various clinical manifestations; therefore, determining the problem’s location, degree, or frequency is often helpful in identifying the precise reason.

Additional helpful information in determining the root of keratitis could include demographic data such as age, gender, and the geographical place of the patient. Medical history, a social history, and a summary of all symptoms can help determine the reason for Keratitis.

Infection is the most common reason for Keratitis. Bacteria and viruses, fungi, and parasitic organisms can cause cornea inflammation, which can cause microbial or infectious Keratitis.

  • The most commonly responsible bacteria for keratitis are Staphylococci, Hemophilus, Streptococci, and Pseudomonas. If the front portion of the cornea is damaged due to a tiny scratch, and the cornea’s surface isn’t wholly resembling its original state, any bacteria, such as mycobacteria atypical, may infiltrate the cornea, causing Keratitis. The cornea can be affected by ulcers and keratitis. Occur, which is called ulcerative corneal keratitis. Before the introduction of the use of antibiotics, syphilis could be a frequently cited cause of keratitis.
  • The cornea-infecting viruses comprise respiratory viruses, such as the adenoviruses and other viruses that cause the common cold. Herpes simplex virus is another major cause of cornea keratitis. It usually causes dendritic keratitis. It is a defect on the cornea’s surface in a tree-branching arrangement. The prevalence of HSV Keratitis is around 1.5 million in the world, which includes 40,000 cases of new blindness every year. Herpes zoster virus (VZV, also known as a varicella-zoster virus, which is responsible for chickenpox and shingles) can also trigger the ailment, mainly when it affects the forehead. It is believed that the U.S. Centers for Disease Control and Prevention (CDC) has recently reported adults to suffer from conjunctivitis and Keratitis that result from the Zika virus. In the year 2020, the COVID-19 virus was identified as the reason for keratitis.
  • Fungi like Candida, Aspergillus, and Nocardia are the most unusual causes of microbial keratitis, typically affecting people who suffer from immunocompromised conditions due to an underlying illness or medication. Fusarium keratitis is a form of fungal infection that occurs mainly in people who wear contact lenses. Bacterial co-infection can complicate fungal keratitis.
  • Contact lens wearers are also prone to Acanthamoeba Keratitis, which is caused by an amebic-infecting parasite. “River blindness,” or onchocercal keratitis, is a different cornea parasite infection rare in countries with developed economies; however widespread among nations of the Third World.

Traumas that are chemical or physical are often the reason for the condition known as keratitis. The wound may then become infected, or it may remain uninfected. Foreign bodies in the cornea that stay in the eye are often the cause of Keratitis.

The ultraviolet light from the sun (snow blindness) and tanning lights or welder’s arc contact lens overwear, as well as chemical agents in liquid form and splashed into the eye or in gases that form fumes, can cause non-infectious cornea inflammation.

Chemical injuries or contact lens-related keratitis can cause punctate-like keratitis with superficial spots where the doctor observes a myriad of damaged skin cells on the affected cornea.

The tear film’s instability could cause changes in the cornea’s surface, resulting in the drying of the corneal epithelium. Keratitis of this type is typically superficial and is called sicca keratitis.

If the eyes are dehydrated, the cornea’s surface cells can die and create filaments on the cornea’s surface, which is referred to as filamentary Keratitis. Inability to shut the eyes properly could result in cornea drying, which is known as exposure Keratitis.

It’s a condition that can manifest in Bell’s palsy. It is a weakness of the facial nerve that can be related to Lyme disease.

The eyelids are a part of the human body. Eyelashes can also trigger keratitis. If the lower eyelid is tilted inward, known as entropion, the eyelashes touch the cornea. The growth of eyelashes incorrectly could cause damage to the surface of the cornea.

Allergies to airborne pollens or bacterial toxins in tears can cause an uninfectious form of cornea inflammation. Autoimmune disorders cause an identical appearance, typically in the peripheral region of the cornea, referred to as limbic or marginal Keratitis.

Patients with rheumatoid arthritis and other immune disorders can suffer from marginal corneal ulcers that cause thinned cornea.

What are the keratitis symptoms and indications?

Keratitis symptoms typically are pain, tearing, redness, blurring, or loss of sight. The pain can range from either severe or mild, depending on the cause and severity of the inflammation. The ability to detect light can occur.

To an observer, the eye could appear red and watery and, if the cornea is suffering from severe keratitis, the transparent cornea can appear grey or have white or gray areas.

What kinds of doctors deal with Keratitis?

If you experience keratitis, it is crucial to be checked immediately by a trained professional to diagnose and treat eye diseases. They include optometrists and ophthalmologists.

What is the process for health professionals to determine if keratitis is a problem?

A diagnosis for keratitis can be determined by an ophthalmologist (a specialist in treating diseases and surgeries on the eyes) by taking a medical review of the eye’s history and physical exam.

The past comprises questions about a previous medical and ocular history, as well as the specific symptoms present at the visit at hand.

The eye exam will consist of examining your vision and an examination of your cornea using a slit light that is a microscope with superior lighting and magnification that allows you to see the entire ocular surface, including the cornea, in great detail.

A special dye with fluorescein, in the form of drops for the eyes, can be placed inside the eyes to aid in the exam.

Suppose the presence of infection is suspected the possibility of a culture being taken from the eye’s surface to identify the bacteria or virus, fungus, or parasite responsible for the cornea inflammation.

Blood tests can be performed in some patients who are suspected of having an underlying illness.

What is the best treatment for Keratitis?

The treatment is based on the reason for the Keratitis. Infectious keratitis typically requires antifungal, antibacterial, or antiviral therapies to cure the condition. This therapy can include prescribed eye drops or pills or even intravenous treatment.

Any conjunctival or corneal foreign body must be eliminated. Wetting drops can be utilized when tear turbulence is believed to be the root cause of Keratitis. The use of steroids is recommended at times to lessen swelling and minimize scarring.

It is essential to do this with care and with care, as some illnesses can worsen due to steroids.

Contact lens wearers are usually advised to stop wearing contact lenses regardless of whether or not the lenses are connected to the underlying cause of Keratitis.

What are the potential complications of keratitis?

The most superficial keratitis, which only involves the cornea’s surface, usually doesn’t cause scarring. Keratitis that is more extensive involves the corneal layers deeper and can cause scarring. If corneal ulcers develop, there could be a scar.

The vision may be affected when the central part of your cornea has been affected. If the keratitis is severe, corneas can perforate and cause a dangerous circumstance.

What is the outlook for the condition known as keratitis?

With a proper diagnosis and the right treatment that includes follow-up, Keratitis is usually treated and does not cause permanent eye impairments.

Is it possible to avoid Keratitis?

Keratitis risk is reduced by using measures to avoid eye injuries and contact lens care that is thorough, including regular cleaning of lenses and quick treatment of any early eye symptoms.

Superficial Punctate Keratitis

Superficial punctate keratitis (1) can be described as corneal inflammation with a variety of causes characterized by scattered slight punctate corneal epithelial loss or damage.

The symptoms include redness, photophobia, lacrimation, and slight loss of vision. The diagnosis is made through a slit-lamp examination. Treatment is based on the cause.

Keratitis with punctate-like features is a common occurrence. All of them could cause it:

  • Conjunctivitis caused by viral conjunctivitis (most typically the adenovirus)
  • Blepharitis
  • Keratoconjunctivitis sicca
  • Trachoma
  • Chemical burns
  • Ultraviolet (UV) light exposure (e.g., welding arcs, sunlamps, and snow glare)
  • Contact lens overwear
  • Systemic drugs (e.g., adenine arabinoside)
  • Preservatives or topical medications can cause toxicity.
  • The facial nerve in the peripheral region is affected (including Bell palsy)

The symptoms include photophobia, feelings of foreign bodies and redness, lacrimation, and a slight decrease in vision.

Ophthalmoscope or slit-lamp examination of the cornea will reveal the characteristic appearance of hazy with numerous punctate speckles stained with the fluorescein.

The cause is conjunctivitis that is viral Adenopathy of the preauricular region is very common, and chemosis can be present.

Keratitis that is a result of adenovirus conjunctiva is resolved spontaneously within three weeks. Blepharitis and keratoconjunctivitis are the most common, and trachoma needs a specific treatment.

If the cause is wearing too many contacts, the condition can be treated by discontinuing contact lenses and Antibiotic Ointment (e.g., Ciprofloxacin 0.3 percent four times per day).

However, the eye isn’t treated as a patch because of the risk that severe infection might result. Contact lens wearers who have superficial punctate keratitis must be checked the following day.

The suspected causative drug in the form of a topical (active ingredient or preservative) should be stopped.

Ultraviolet Keratitis

Ultraviolet (UV) Blight (wavelength < 300 nm) can burn the cornea, causing keratitis or keratoconjunctivitis. Arc welding is the most common reason; even a glance, without protection, at an arc welding may cause a burn.

Other causes include high-voltage electricity sparks or artificial sun lamps and the reflection of sunlight off the snow at high elevations. UV radiation rises by 4 to 6percent for every 1000 feet (305-m) rise in altitude above sea level. Additionally, snow reflects 85percent of UVB.

The symptoms usually do not show for between 8 and 12 hours after exposure. They will last between 24 and 48 hours.

Patients may experience pain, lacrimation and redness, swelling of the eyelids, headache, photophobia, foreign body sensation, and diminished vision. Loss of vision permanently is exceptionally uncommon.

The diagnostic criteria are histology, punctate keratitis, and the absence of a foreign body or an infection.

Treatment involves an antibiotic Ointment (e.g., bacitracin, gentamicin, or 0.3 10% ointment every eight hours) and, occasionally, a quick-acting cycloplegic medication (e.g., cyclopentolate, one drop every 4 hours).

The most severe pain might require analgesics for the entire system (e.g., Acetaminophen 500 mg every four days throughout the day for up to 24 hours). The cornea’s surface is regenerated rapidly in the span of 24 to 48 hours.

The eye needs to be examined within 24 hours. The use of dark glasses or welding helmets that can block UV light can prevent.

Symptoms of Superficial Punctate Keratitis

In the case of superficial punctate keratitis, the eyes tend to be uncomfortable, watery, vulnerable to intense light, and bloodshot.

The vision can be a little blurred. Sometimes, there is an intense, gritty sensation or the feeling that a foreign object has been trapped within the eye.

When light from ultraviolet causes the disorder, the symptoms typically don’t manifest until a few hours after exposure. And the symptoms last from 1 to 2 days.

If a virus triggers the illness, a lymph node located in the front of the ear located on the side affected could be tender and swelling.

Diagnosis of Superficial Punctate Keratitis

  • A doctor’s assessment

It is the diagnosis that requires a superficial punctate Keratitis is determined by the signs and on the possibility that the patient was exposed to any of the known causes and also on a thorough inspection of the cornea using the help of a slit lamp (a tool that permits doctors to look at the eye with the microscope at high magnification).

During the exam, the doctor might apply drops to the vision that contain a yellow-green pigment known as fluorescein. The fluorescein temporarily marks corneas that are damaged which allows you to identify the damaged areas that aren’t otherwise obvious.

Treatment of Superficial Punctate Keratitis

  • Treatment is based on the cause.

Nearly everyone with the disorder is completely recovered.

If the source is the result of a virus (other than herpes simplex eye disease or herpes zoster infection in the eyes [shingles(shingles), No treatment is required, and the recovery typically takes three weeks to heal.

If the reason is an infection caused by bacteria or prolonged wear of contact lenses, antibiotics are prescribed to treat the problem, and wearing contact lenses is stopped temporarily.

If the reason is eye dryness, the ointments or artificial tears can be efficient. Artificial tears are drops for the eyes created with ingredients that simulate real tears or contain chemicals that add to tears; they cover the eyes with more moisture.

If the problem is due to exposure to UV light, an antibiotic ointment and an eye drop that dilates the pupil could help.

If the cause is a reaction to a drug or an allergic reaction to drops for eyes, the substance or eye drops should be stopped.

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