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Interstitial Keratitis

Interstitial keratitis is a form of inflamma-tion which is nearly always due to syphilis, usually of the congenital type; it occurs in children with congenital syphilis between six and sixteen years.

The conjunctiva may be seen to be of a salmon-pink colour; later, the cornea becomes dull or 'steamy', looking like ground glass. The disease is chronic and affects both eyes; relapses are common. See colour plate section.

The sight is much impaired in the active stage but later the cornea begins to clear and vision may return; in severe cases a triangular scar is left. Medical attention is essential.

The complications which may occur are iritis, inflammation of the choroid coat of the eye, and sometimes glaucoma. Corneal ulceration is rare. Short sight may follow iritis, owing to deformity of the cornea with forward bulging.

Treatment

General antisyphilitic treatment is required. Atropine drops are used to prevent iritis and adhesions unless glaucoma is present, while cortisone is given in the hope of cutting down the ultimate scarring.

When the attack is over, the resultant scars are amenable for replacement by corneal grafts.

Arcus Senilis

This condition is usually seen in elderly persons and is caused by a deposit of fat in the cornea, which forms two white crescentic lines in the upper and lower parts of the cornea; there is often a family tendency to its development, and there may also be some degenerative changes in the blood vessels of the body.

Iritis

The iris is the coloured ring which lies in front of the lens of the eye; in health it is continually contracting or dilating to admit more or less light to the eye.

Causes

The iris may become inflamed after injury, or as a result of wounds or operations on the eye, but it is also a common sequel to rheumatism, gonorrhoea and syphilis.

Cases of Iritis Fall into Three Groups:

  1. Iritis Secondary To External In-fecrtion, in which the inflammation is caused by the spread of the infection from the con-junctiva, by corneal ulcers, or by perforating wounds.
  2. Non-Specific Iritis. Most cases fall into this group where there is no obvious cause, and in turn syphilis, tuberculosis, bad teeth, allergies, and metabolic upsets have been blamed. Usually, however, investigation shows none of the above to be present.
  3. Irido-Cyclitis, or serous iritis, is a chronic disease of slow progress, occurring in persons with poor health. Small white points are formed on the cornea as a result of the inflammatory process.

Symptoms

In all forms of inflammation of the iris, the movements of the iris are impaired and there is the likelihood of the iris becoming adherent to the lens. It is very important to recognise cases of iritis at their onset, so that atropine may be used to dilate the pupil and prevent such adhesions.

In iritis the cornea looks muddy and the pupil sluggish or fixed; the conjunctiva is congested and there is pain and headache, with dislike of light.

Complications

If any case of iritis is neglected, blindness may follow or glaucoma may develop. Even with adequate treatment there may be some loss of sight, but in favourable cases recovery is nearly complete.

Treatment

In all cases atropine sulphate (as a 1 per cent solution) should be instilled three times a day for about two days, and then less often if the adhesions soften.

Alter-natively other mydriatics such as adrenaline or homatropine may be used to dilate the eye. Prednisone cuts down the inflammatory re-sponse and may be used in place of atropine.

The eye should be kept at rest by a shade, or the patient may stay in a dark room. The pain is relieved by analgesics. Sedatives may also be required.

If finally many adhesions remain, an opera-tion called iridectomy may be performed, in which a small part of the iris is removed.

General Treatment

Because the eye affection is usually part of a systemic infection, the patient needs rest in bed for some days, and a convalescence in fresh air.

In syphilitic iritis, general antisyphilitic treatment is essential. In rheumatic iritis, aspirin or sodium salicylate should be taken.

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