Filamentary Keratitis

Tuesday, Jan 2, 2024 by Nisha Gupta, MD

This month we will discuss filamentary keratitis. Keratitis is an inflammation of the cornea.

What is filamentary keratitis?

Filamentary keratitis is a condition where filaments or fine strands of mucus and cells develop due to too much production of mucus and not enough tears in the eye. These strands stick to the surface of the cornea causing pain and sensation of something in the eye. This can also cause redness and light sensitivity.

What are the risk factors?

Any changes in the surface of the cornea can cause filamentary keratitis and put one at higher risk of developing it. Common risks are:

  • Dry eye disease
  • Systemic condition causing dryness such as Sjogren’s syndrome
  • Exposure of the cornea due to a nerve paralysis
  • Droopy eyelid
  • Eye surgery
  • Long term use of some medications
  • Other conditions that affect the eye surface such as superior limbic keratoconjunctivitis

How is it detected?

A thorough slit lamp exam of the eyelids and eye surface is completed. The filaments are seen on the cornea surface.

What are the treatments for filamentary keratitis?

The treatment for this keratitis is focused on treating the underlying issue. It can take time to improve. Initially, the treatment is similar to that of dry eye syndrome.

Lubricating drops: These are eye drops that are like your own tears. These may be used throughout the day. Sometimes doctors recommend using preservative free tears if one has an allergy to the preservatives or is using the drops very frequently.

Gels and ointments: These are thicker versions of the tears. These can make the vision blurry so are usually used at night and can have a longer lasting effect than drops.

Prescription drops: Doctors may prescribe medications that decrease the production of the mucus. Sodium chloride drops can help with the corneal swelling. Occasionally, steroids or other anti-inflammatory drops may be used for a short time if the eyes are very irritated.

Bandage contact lens: This lens can be placed in the eye for a short period of time to help the surface heal and prevent the eyelid from scratching the surface while blinking. Antibiotic drops are usually used while these lenses are in place.

Punctal plugs: Small plugs may be used to block the tear ducts in the eyelids. This helps to keep the tears in the eyes longer. The plugs are placed in the clinic and are helpful for patients who do not make enough tears.

Manual removal: The filaments can be removed in the clinic in addition to the treatments above.

Omega 3 vitamins: Studies have shown that these vitamins can help with dry eyes.

Humidifier: This will add moisture to the air especially in the winter months.

Other tips: Avoid any air blowing into the eyes including heat and air from air vents. Avoid running a ceiling fan. Take frequent breaks to prevent staring at computer screens, phones, TVs, books, and tablets.

Return next month for a discussion on a new topic!

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