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Keratoconjunctivitis: Causes, Symptoms & Treatment

Keratoconjunctivitis is a simultaneous inflammation of the cornea and the conjunctiva of the eye. It causes redness, pain, and visual disturbances.

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Things worth knowing about "Keratoconjunctivitis"

Keratoconjunctivitis is a simultaneous inflammation of the cornea and the conjunctiva of the eye. It causes redness, pain, and visual disturbances.

What is Keratoconjunctivitis?

Keratoconjunctivitis is an inflammatory condition of the eye in which both the cornea and the conjunctiva are affected at the same time. The term is derived from the Greek words for cornea (kerato), conjunctiva, and inflammation (-itis). Unlike simple conjunctivitis, keratoconjunctivitis involves the cornea as well, which increases the risk of permanent visual impairment if left untreated.

Types and Causes

There are several forms of keratoconjunctivitis, each differing in cause and clinical course:

Infectious Keratoconjunctivitis

Viral causes: Most commonly caused by adenoviruses (epidemic keratoconjunctivitis), but also by herpes simplex virus or varicella-zoster virus.
Bacterial causes: Bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, or Chlamydia trachomatis (trachoma) can trigger the condition.

Non-infectious Keratoconjunctivitis

Allergic keratoconjunctivitis: Triggered by allergens such as pollen, animal dander, or house dust mites.
Keratoconjunctivitis sicca (Dry Eye Disease): Caused by insufficient tear production or an unstable tear film composition.
UV-induced keratoconjunctivitis (Photokeratoconjunctivitis): Results from intense ultraviolet radiation exposure, such as welding without protective eyewear or sun reflection on snow (snow blindness).
Autoimmune-related forms: Associated with systemic conditions such as Sjogren syndrome or rheumatoid arthritis.

Symptoms

Symptoms can vary depending on the underlying cause, but common signs include:

Intense burning sensation and eye pain
Redness of the eyes (hyperaemia)
Light sensitivity (photophobia)
Excessive tearing or, conversely, a feeling of dryness
Foreign body sensation in the eye
Blurred vision or reduced visual acuity
Purulent or watery discharge from the eye (depending on cause)
Swollen eyelids

Diagnosis

Diagnosis is typically made by an ophthalmologist using the following methods:

Slit-lamp examination: Detailed assessment of the cornea and conjunctiva under magnification and special lighting.
Swab and laboratory testing: To identify bacterial or viral pathogens.
Schirmer test: Measures tear production when keratoconjunctivitis sicca is suspected.
Allergy testing: When an allergic cause is suspected.
Fluorescein staining: Highlights corneal defects using a dye.

Treatment

Treatment depends on the underlying cause of keratoconjunctivitis:

Infectious Forms

Viral: No specific antiviral therapy is available for adenovirus infections; treatment is symptomatic (cooling eye drops, strict hygiene). For herpes simplex keratoconjunctivitis, antiviral eye drops or ointments (e.g., aciclovir) are used.
Bacterial: Antibiotic eye drops or ointments (e.g., tobramycin or ciprofloxacin).
Chlamydial (trachoma): Systemic antibiotic therapy, e.g., with azithromycin.

Non-infectious Forms

Allergic: Antihistamine eye drops, mast cell stabilisers, and avoidance of allergens.
Keratoconjunctivitis sicca: Artificial tears (lubricating eye drops), punctal plugs to reduce tear drainage, and anti-inflammatory eye drops (e.g., ciclosporin).
UV-induced: Cooling, moist compresses, and pain-relieving eye drops; this form typically resolves within a few days.

Complications and Prognosis

With timely and appropriate treatment, keratoconjunctivitis usually resolves completely. However, if left untreated or diagnosed late, serious complications can arise:

Corneal scarring (opacities) that can permanently impair vision
Corneal ulcers (ulcus corneae)
Chronic inflammation
Spread of inflammation to deeper ocular structures

Prevention

Regular handwashing, especially during viral outbreaks
Use of protective eyewear during UV exposure (e.g., welding, high-altitude environments)
Avoiding known allergens
Regular ophthalmological check-ups for patients with chronic conditions (e.g., Sjogren syndrome)
Proper handling and care of contact lenses

References

Kanski, J. J. & Bowling, B. (2016). Clinical Ophthalmology: A Systematic Approach. 8th edition. Elsevier.
World Health Organization (WHO). Trachoma Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/trachoma
Pflugfelder, S. C. et al. (2017). Dry Eye Disease: Emerging Approaches to Treatment. JAMA Ophthalmology, 135(8), 841–842.

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