Filamentary keratitis is a chronic and painful corneal condition in which small tags of degenerated epithelium and mucus hang off or adhere to the corneal surface. The tags are extensive and may trap bacteria, and dust particles.

Filamentary keratitis is most often accompanied with dry eye syndrome and an associated underlying systemic condition, particularly connective tissue disorders. It can be chronic and debilitating, with recurrent exacerbations.

Causes of Filamentary keratitis

The factors that will alter the composition of tear film along with abnormalities of cornea are the main cause of filamentary keratitis. The reasons for these include:

  • Persistent dry eye
  • Prolonged eye patching
  • Ptosis (drooping of the upper lid)
  • Corneal transplantation
  • Ocular surgery
  • Occlusion abnormalities such as blepharoptosis
  • Certain infections

Risk factors for Filamentary keratitis

There are certain factors whose presence increases the chances of a person developing filamentary keratitis. These include the following:

  • Elderly individuals
  • Females
  • Individuals with connective tissue disorders or immune deficiency
  • Sjogren’s syndrome
  • Aqueous tear deficiency
  • Corneal exposure
  • Excessive use of anticholinergic medications

Symptoms of Filamentary keratitis

Filamentary keratitis is a painful condition that leads to following symptoms in the patients suffering from it:

  • Dryness in eye
  • Red eye
  • Increased blinking
  • Mild eye discomfort
  • Eye pain
  • Excessive tearing
  • Irritation in eye
  • Foreign body sensation exacerbated by blinking
  • Photophobia
  • Blurred vision

Diagnosis of Filamentary keratitis

The diagnosis of filamentary keratitis involves thorough history taking of the patient along with eye examination and following diagnostic procedures:

  • Slit lamp bio microscopy
  • Schirmer’s test
  • Rose bengal dye
  • Hematologic workup to investigate for conditions such as Sjogren’s syndrome, rheumatoid arthritis, and thyroid disease.

Treatment of Filamentary keratitis

As filamentary keratitis is a chronic and recurring condition, its treatment may take weeks or even months before adequate resolution is realized. Treatment typically depends upon the cause, severity and aggressiveness of disease and may include following:

  • Removal of large filaments mechanically using fine-tipped forceps at the slit lamp under topical anaesthesia
  • Ocular lubricants
  • Topical N-acetylcysteine (mucolytic agent)
  • 10% acetylcysteine eye drops
  • Use of bandage soft contact lenses
  • Amniotic membrane therapy
  • Botox injection
  • Anti-inflammatory drugs such as corticosteroids and non-steroidal agents
  • Autologous serum eye drops