See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/325267942

Filamentary Keratitis

Article  in  Delhi Journal Of Ophthalmology · April 2018

DOI: 10.7869/djo.364

CITATIONS READS
0 162

1 author:

Mukta Sharma

8 PUBLICATIONS   5 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Mukta Sharma on 15 September 2018.

The user has requested enhancement of the downloaded file.

 DJO
67
E-ISSN 2454-2784

Brief Communication
Filamentary Keratitis
Mukta Sharma, Arti Sareen, S.S. Negi
Himachal Pradesh University Department of Ophtrhalmology, DDU Zonal Hospital, Shimla, India
Filamentary keratitis is a corneal condition characterized by multiple filaments attached to areas
of compromised corneal epithelium. On blinking, the loose ends of filaments get pulled causing
pain and foreign body sensation. Dry eye is a common association of filamentary keratitis. Here we
present a case of a female who presented with the similar complaints for the last 1 month. Filaments
Abstract
were removed mechanically and she was put on treatment. She was relieved of her symptoms and
was cured after 2 weeks. Thus it would be wise to mention that Filamentary Keratitis is a recurrent
painful condition which is difficult to treat. But if properly managed, it can be treated and normal
corneal epithelium can be restored.

Delhi J Ophthalmol 2018;28;67-8; Doi; http://dx.doi.org/10.7869/djo.364

Keywords: keratitis, foreign body, visual acuity

Introduction
Filamentary keratitis is a condition in which filaments
composed of degenerated epithelial cells and mucus
develop on and adhere to the corneal surface causing pain
and foreign body sensation.

Case Report
A 50 year old female presented to the OPD with complaints
of watering and foreign body sensation in the left eye for the
last 1 month. She had taken treatment for her complaints at
several places before. On examination, Visual Acuity was 6/6
in both the eyes. On slit lamp examination, multiple filaments
were present in the inferior half of the cornea, which were
better visualized after fluorescein staining. (Figure 1 & 2).
Filaments were removed manually. The patient was put on
eyedrops Moxifloxacin, N-Acetyl cysteine and lubricating
ointment and was reviewed after 1 week. After 1 week,
she was symptomatically better. Few filaments were again
removed. On next visit, the patient was relieved (Figure 3).

Figure 2: Fluorescein stained picture aids in visualizatin of the filaments

Figure 3: Post treatment picture showing clear cornea

Figure 1: Slit Lamp Examination showing filaments on cornea

www.djo.org.in Delhi Journal of Ophthalmology

 DJO
68
Brief Communication
Discussion
Filamentary keratitis is a condition related to an alteration
in the component of tear film. Common risk factors include
aqueous tear deficiency, corneal exposure, extended use of
anti cholinergic medications etc.1
Pathogenesis: Decreased tear production leads to increase
in tear film mucus to aqueous ratio. This results in the
accumulation of mucinous components. Small defects in
the corneal epithelium provides niche for the attachment of
mucoid filaments. Loose epithelial strands are incorporated
into the mucin strands.2 Filaments may be sessile adhesions
or long strands. Filaments consists of focal head which
may firmly adhere to compromised areas of the corneal
epithelium and a strand like tail of varying length that
extends across the ocular surface. Filaments consists
of desquamated corneal epithelial cells surrounded by
conjunctival epithelial cells and entwined in a thick layer
of mucin.3 Frictional stress from blinking results in vertical
traction and shearing of corneal epithelium resulting in
stimulation of corneal nerves and therefore pain, irritation
and discomfort. Thus a vicious cycle of epithelial damage
and filament formation ensues.
Treatment: First line treatment includes preservative
free topical lubricant drops and ointment. Filaments can
be removed mechanically. Topical anti inflammatory
agents also have a role to play. Bandage contact lens may
also be tried in cases that do not respond to lubrication
alone. Punctal occlusion may also be helpful in cases with
underlying aqueous tear deficiency.4,5
Volume 28 Number 4 April - June 2018
View publication stats
P-ISSN 0972-0200
References
1. Van Meter WS, Katz D, Cook BG. Filamentary keratitis. In:
Holland EJ, Mannis MJ, Lee WB, editors. Ocular Surface
Disease : Cornea, Conjunctiva and Tear Film. Philadelphia :
Elsevier Saunders ; 2013.P.213-6.
2. Zaidman GW, Geeraets R, Paylor RR, et al. The histopathology
of filamentary keratitis. Arch Ophthalmology 1985;103:1178-81.
3. Tanioka H, Yokoi N, Komura A,et al. Investigation of corneal
filament in Filamentary keratitis. Invest Ophthalmol Vis Sci
2009; 50:3696-702.
4. Sheppard JD, Donnenfeld ED, Holland EJ, Slonim CB, Solomon
R, Solomon KD, et al. Effect of loteprednol etabonate 0.5% on
initiation of dry eye treatment with topical cyclosporine 0.05%.
Eye Contact Lens 2014; 40:289-96.
5. Hussain M, Shtein RM, Sugar A, Soong HK, Woodward MA,
DeLoss K, et al. Long term use of autologus serum 50 % for the
treatment of dry eye diseases. Cornea 2014; 33:1245-51.
Cite This Article as: Sharma M, Sareen A, Negi S.S. Filamentary
Keratitis.
Acknowledgements: None
Conflict of interest: None declared
Source of Funding: None
Date of Submission: 24 September 2017
Date of Acceptance: 15 March 2018
Address for correspondence
Mukta Sharma
Medical Officer
Himachal Pradesh University,
Department of Ophthalmology,
DDU Zonal Hospital, Shimla, India
Email id: muktasharma001@gmail.com
Quick Response Code