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inflammation of the cornea causing watery painful eyes and blurred vision

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/29 19:04:58」(JST)

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Keratitis is a condition in which the eye's cornea, the front part of the eye, becomes inflamed. The condition is often marked by moderate to intense pain and usually involves any of the following symptoms: pain, impaired eyesight, photophobia, red eye and a 'gritty' sensation.^[1]

1 Classification (by chronicity)
- 1.1 Acute
- 1.2 Chronic
2 Classification (infective)
- 2.1 Viral
- 2.2 Bacterial
- 2.3 Fungal
- 2.4 Amoebic
- 2.5 Parasitic
3 Classification (by stage of disease)
4 Classification (by environmental aetiology)
5 Forms of Keratitis in non-humans
6 Treatment
7 Prognosis
8 See also
9 References
10 External links

Classification (by chronicity)

Acute

Acute epithelial keratitis
Nummular keratitis
Interstitial keratitis
Disciform keratitis

Chronic

Neurotrophic keratitis
Mucous plaque keratitis

Classification (infective)

Viral

Herpes simplex keratitis (dendritic keratitis). Viral infection of the cornea is often caused by the herpes simplex virus which frequently leaves what is called a 'dendritic ulcer'.
Herpes zoster keratitis, associated with Herpes zoster ophthalmicus, which is a form of Shingles.

Bacterial

Bacterial keratitis. Bacterial infection of the cornea can follow from an injury or from wearing contact lenses. The bacteria involved are Staphylococcus aureus and for contact lens wearers, Pseudomonas aeruginosa. Pseudomonas aeruginosa contains enzymes that can digest the cornea.^[2]

Fungal

Fungal keratitis (cf. Fusarium, causing recent incidences of keratitis through the possible vector of Bausch & Lomb ReNu with MoistureLoc contact lens solution)

Amoebic

Acanthamoebic keratitis

Acanthamoeba keratitis

Amoebic infection of the cornea is a serious corneal infection, often affecting contact lens wearers.^[3]^[4] It is usually caused by Acanthamoeba. On May 25, 2007, the CDC issued a health advisory due to increased risk of Acanthamoeba keratitis (AK) associated with use of Advanced Medical Optics (AMO) Complete Moisture Plus Multi-Purpose eye solution.^[5]

Parasitic

Onchocercal keratitis, which follows O. volvulus infection by infected blackfly bite. These blackfly usually dwell near fast-flowing African streams, so the disease is also called "river blindness".^[6]

Classification (by stage of disease)

Superficial punctate keratitis
Ulcerative keratitis

Classification (by environmental aetiology)

Exposure keratitis — due to dryness of the cornea caused by incomplete or inadequate eyelid closure.
Photokeratitis — keratitis due to intense ultraviolet radiation exposure (e.g. snow blindness or welder's arc eye.)
Contact lens acute red eye (CLARE) — a non-ulcerative sterile keratitis associated with colonization of Gram-negative bacteria on contact lenses.

Forms of Keratitis in non-humans

Feline eosinophilic keratitis — affecting cats and horses; possibly initiated by feline herpesvirus 1 or other viral infection.^[7]

Treatment

Treatment depends on the cause of the keratitis. Infectious keratitis can progress rapidly, and generally requires urgent antibacterial, antifungal, or antiviral therapy to eliminate the pathogen. Antibacterial solutions include levofloxacin, gatifloxacin, moxifloxacin, ofloxacin. It is unclear if steroid eye drops are useful or not.^[8]

In addition, contact lens wearers are typically advised to discontinue contact lens wear and replace contaminated contact lenses and contact lens cases. (Contaminated lenses and cases should not be discarded as cultures from these can be used to identify the pathogen).

Aciclovir is the mainstay of treatment for HSV keratitis and steroids should be avoided at all costs in this condition. Application of steroids to a dendritic ulcer caused by HSV will result in rapid and significant worsening of the ulcer to form an 'amoeboid' or 'geographic' ulcer, so named because of the ulcer's map like shape.^{[citation needed]}

Prognosis

Some infections may scar the cornea to limit vision. Others may result in perforation of the cornea, (an infection inside the eye), or even loss of the eye. With proper medical attention, infections can usually be successfully treated without long-term visual loss.

References

^ Keratitis
^ Tang A, Marquart ME, Fratkin JD, McCormick CC, Caballero AR, Gatlin HP, O'Callaghan RJ (2009). "Properties of PASP: A Pseudomonas Protease Capable of Mediating Corneal Erosions". Invest Ophthalmol Vis Sci 50 (8): 3794–801. doi:10.1167/iovs.08-3107. PMC 2874894. PMID 19255155.
^ Lorenzo-Morales, Jacob; Khan, Naveed A.; Walochnik, Julia (2015). "An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment". Parasite 22: 10. doi:10.1051/parasite/2015010. ISSN 1776-1042. PMID 25687209.
^ Martín-Navarro, M.; Lorenzo-Morales, J.; Cabrera-Serra, G.; Rancel, F.; Coronado-Alvarez, M.; Piñero, E.; Valladares, B. (Nov 2008). "The potential pathogenicity of chlorhexidine-sensitive Acanthamoeba strains isolated from contact lens cases from asymptomatic individuals in Tenerife, Canary Islands, Spain". Journal of medical microbiology 57 (Pt 11): 1399–1404. doi:10.1099/jmm.0.2008/003459-0. ISSN 0022-2615. PMID 18927419. edit
^ CDC Advisory
^ "What is onchocerciasis?". CDC. Retrieved 2010-06-28. transmission is most intense in remote African rural agricultural villages, located near rapidly flowing streams...(WHO) expert committee on onchocerciasis estimates the global prevalence is 17.7 million, of whom about 270,000 are blind.
^ VET.uga.edu
^ Herretes, S; Wang, X; Reyes, JM (Oct 16, 2014). "Topical corticosteroids as adjunctive therapy for bacterial keratitis.". The Cochrane database of systematic reviews 10: CD005430. doi:10.1002/14651858.CD005430.pub3. PMID 25321340.

External links

Facts About the Cornea and Corneal Disease The National Eye Institute (NEI)
Filimentary keratitis

UpToDate Contents

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1. 眼の充血（red eye）の評価 evaluation of the red eye
2. 単純ヘルペス性角膜炎 herpes simplex keratitis
3. コンタクトレンズの合併症 complications of contact lenses
4. 視覚変化が認められた小児患者に対するアプローチ approach to the pediatric patient with vision change
5. コンタクトレンズの概要 overview of contact lenses

English Journal

A nanoparticle formulation reduces the corneal toxicity of indomethacin eye drops and enhances its corneal permeability.

Nagai N1, Ito Y2, Okamoto N3, Shimomura Y3.Author information 1Faculty of Pharmacy, Kinki University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan.2Faculty of Pharmacy, Kinki University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan. Electronic address: itoyoshi@phar.kindai.ac.jp.3Department of Ophthalmology, Kinki University, Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.AbstractIndomethacin (IMC) has been shown to reduce post-operative inflammation and to decrease intraocular irritation after cataract extraction and in cystoid macular edema; however, the clinical use of its most commonly used eye drops is limited due to topical side-effects that include burning sensation, irritation and epithelial keratitis. It is known that decreasing direct cell stimulation and reducing the amount applied via increasing bioavailability are useful for improving these issues. In this study, we designed ophthalmic formulations containing 0.5% IMC nanoparticles using zirconia beads and Bead Smash 12 (IMCnano eye drops; particle size 76±59nm, mean±S.D.), and investigated the corneal toxicity of these IMCnano eye drops. IMCnano eye drops are tolerated better by a human cornea epithelial cell line (HCE-T) than commercially available NDSAIDs preparations (IMC, pranoprofen, diclofenac, bromfenac and nepafenac eye drops), and corneal wound healing in rat eyes with debrided corneal epithelium instilled with IMCnano eye drops is significantly better than that of eyes instilled with commercially available IMC eye drops. In addition, the accumulation of IMC in HCE-T cells treated with the IMCnano eye drops for 30min was 19.9% that of the accumulation from commercially available IMC eye drops. On the other hand, the corneal penetration of IMC from IMCnano eye drops was significantly greater than in the case of the commercially available IMC eye drops in both in vivo and in vitro studies using rabbit corneas. Taken together, we hypothesize that a nanoparticle formulation reduces the corneal toxicity of IMC eye drops, probably because the accumulation of IMC from IMCnano eye drops in the eye is lower than that from commercially available IMC eye drops. In addition, the nanoparticle formulation may allow a decrease in the amount of IMC used due to the increase in bioavailability, resulting in reduced drug toxicity. These findings provide significant information that can be used to design further studies aimed at developing less toxic eye drops.
Toxicology.Toxicology.2014 May 7;319:53-62. doi: 10.1016/j.tox.2014.02.012. Epub 2014 Mar 2.
Indomethacin (IMC) has been shown to reduce post-operative inflammation and to decrease intraocular irritation after cataract extraction and in cystoid macular edema; however, the clinical use of its most commonly used eye drops is limited due to topical side-effects that include burning sensation,
PMID 24598350

Pediatric microbial keratitis in taiwan: clinical and microbiological profiles, 1998-2002 versus 2008-2012.

Lee YS1, Tan HY2, Yeh LK2, Lin HC2, Ma DH2, Chen HC2, Chen SY2, Chen PY2, Hsiao CH3.Author information 1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.2Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.3Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: hsiao.chinghsi@gmail.com.AbstractPURPOSE: To identify the change in clinical and microbiological profiles of pediatric microbial keratitis in Taiwan between 1998-2002 and 2008-2012.
American journal of ophthalmology.Am J Ophthalmol.2014 May;157(5):1090-1096.e1. doi: 10.1016/j.ajo.2014.01.013. Epub 2014 Jan 30.
PURPOSE: To identify the change in clinical and microbiological profiles of pediatric microbial keratitis in Taiwan between 1998-2002 and 2008-2012.DESIGN: Retrospective, observational study.METHOD: setting: Chang Gung Memorial Hospital, a referral center in Taiwan. patient population: We retrospect
PMID 24487048

Effects of tobacco smoking on human corneal wound healing.

Jetton JA1, Ding K, Kim Y, Stone DU.Author information 1Departments of *Ophthalmology, Dean A. McGee Eye Institute; and †Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK.AbstractPURPOSE: To evaluate the effect of tobacco smoking on healing of corneal abrasions and keratitis in humans.
Cornea.Cornea.2014 May;33(5):453-6. doi: 10.1097/ICO.0000000000000100.
PURPOSE: To evaluate the effect of tobacco smoking on healing of corneal abrasions and keratitis in humans.METHODS: A retrospective chart review of patients diagnosed with corneal abrasions and corneal ulcers from 1990 to 2010 at the Dean McGee Eye Institute was performed. The primary outcome measur
PMID 24619165