R R

What Is Interstitial Keratitis?

Interstitial keratitis is a non suppurative inflammation of the corneal stroma that usually spares the epithelium and endothelium. It leads to stromal haze, vascularization, and sometimes scarring. Classic causes include congenital and acquired syphilis, but herpes simplex, herpes zoster, tuberculosis, Lyme disease, and autoimmune conditions can also be involved. Symptoms range from redness and pain to significant visual loss when the visual axis is affected. Early diagnosis and treatment help limit permanent damage.

Link to This Resource Page

Provide a valuable resource to your clients or customers by linking to this resource page. Just place the following link on your website.

To display this...

What Is Interstitial Keratitis?

Interstitial keratitis is a non suppurative inflammation of the corneal stroma that usually spares the epithelium and endothelium. It leads to stromal haze, vascularization, and sometimes scarring. Classic causes include congenital and acquired syphilis, but herpes simplex, herpes zoster, tuberculosis, Lyme disease, and autoimmune conditions can also be involved. Symptoms range from redness and pain to significant visual loss when the visual axis is affected. Early diagnosis and treatment help limit permanent damage.

read more about interstitial keratitis ...

Copy this HTML:

Copy HTML Copied!

Causes of Interstitial Keratitis

Historically, congenital syphilis has been a well known cause, often presenting in childhood or early adulthood. Acquired syphilis, herpes simplex, herpes zoster, and other infections such as tuberculosis and Lyme disease are important in many regions. Autoimmune and inflammatory disorders, including sarcoidosis and Cogan syndrome, can also cause stromal inflammation. In some cases, no clear cause is found and the condition is labeled idiopathic. Identifying the underlying source is important for systemic management.

Symptoms and Clinical Features

Patients often notice redness, photophobia, tearing, and blurred vision. Pain can vary with the level of inflammation. On slit lamp exam, the corneal epithelium is usually intact, while the stroma shows diffuse or patchy haze, fine infiltrates, and later, deep vessels growing in from the limbus. In congenital syphilis, the vascular pattern can be characteristic and bilateral. Old or inactive disease may leave ghost vessels and stromal scarring with reduced acuity.

How Is Interstitial Keratitis Diagnosed?

Diagnosis combines corneal findings with systemic evaluation. The eye doctor looks for stromal haze and vascularization with minimal epithelial involvement. Blood tests for syphilis, tuberculosis, Lyme disease, and autoimmune markers are chosen based on local patterns and patient history. Imaging and specialist consultations, such as infectious disease or rheumatology, help uncover associated systemic illness. Distinguishing interstitial keratitis from infectious microbial keratitis, which usually has more epithelial loss and suppuration, guides treatment choices.

How Is Interstitial Keratitis Managed?

Treatment has two parts: systemic therapy for the underlying disease and local therapy for ocular inflammation. Syphilitic cases require appropriate antibiotic regimens, often with penicillin under infectious disease guidance. Topical steroids and cycloplegic drops help calm stromal inflammation and reduce pain once active infection is addressed. Lubricants support comfort and surface health. Long term follow up monitors for recurrence and manages residual scarring, which sometimes needs optical correction with contact lenses or, rarely, corneal transplantation.

FAQs About Interstitial Keratitis

Is interstitial keratitis always caused by syphilis?

No, syphilis is a classic cause but many other infections and autoimmune diseases can produce similar stromal changes. Modern workup checks for several possibilities based on history and local disease patterns.

Can vision return to normal after interstitial keratitis?

Vision can improve substantially if treatment starts early and scarring is limited. Long standing or severe cases often leave some haze or irregular astigmatism, but specialty contact lenses can improve image quality.

Is interstitial keratitis contagious?

The corneal inflammation itself is not contagious, but some underlying infections, such as syphilis or tuberculosis, can spread through their usual routes. Systemic treatment and public health measures address that risk.

Will I need surgery for interstitial keratitis scars?

Many patients manage well with glasses or contact lenses even when some scarring persists. Corneal transplantation is reserved for cases where scarring severely affects daily activities despite optical correction.