Treatment of interface keratitis with oral corticosteroids

To describe the results of treating interface keratitis using a combination of intensive topical and oral corticosteroids.

Casey Eye Institute, Portland, Oregon, USA.

Thirteen eyes treated for grade 2 to 3 interface keratitis using an oral corticosteroid (prednisone 60 to 80 mg) as well as an hourly topical corticosteroid were retrospectively reviewed. The best corrected visual acuity (BCVA) was used as an objective guide of whether to treat with intense topical and oral corticosteroids, flap irrigation, or both. Predisposing factors such as intraoperative epithelial defects or a history of severe allergies or atopy were also looked for.

All 13 eyes responded favorably to the combination of intensive topical and oral corticosteroids and had a BCVA of 20/20 after the keratitis resolved. In 6 eyes (46%), the patients had a history of severe seasonal allergies. One day postoperatively, 3 eyes (23%) had an epithelial defect and 2 eyes (15%), lint particles or debris embedded in the interface. With oral corticosteroid use, 3 patients (23%) noted mild stomach irritation and 2 (15%) noted nervousness. All 5 side effects resolved without sequelae. No patient developed a serious side effect.

A short, intense course of an oral corticosteroid was an effective treatment in patients with grade 2 or higher interface keratitis when combined with a topical corticosteroid administered hourly. The BCVA is a helpful objective measure of the severity of interface keratitis and can be used to guide the clinician in the therapeutic strategy.