Filamentary Keratitis: A Persistent Challenge in Ocular Surface Disease

Area of Science:

• Ophthalmology
• Ocular Surface Disease

Background:

• Filamentary keratitis (FK) is a chronic ocular surface disorder characterized by mucus-epithelial filaments on the cornea.
• It is frequently associated with dry eye disease, autoimmune conditions, and neurotrophic or exposure keratopathies.

Purpose of the Study:

• To offer a comprehensive review of filamentary keratitis.
• Covering its pathophysiology, associated conditions, clinical signs, and current management strategies.

Main Methods:

• A narrative literature review was conducted.
• Focusing on etiopathogenesis, clinical features, and therapeutic strategies for FK, including conventional, advanced medical, and surgical options for refractory cases.

Main Results:

• FK pathogenesis involves tear film instability, excessive mucus, and blinking trauma.
• Standard treatments include lubrication, debridement, corticosteroids, and mucolytics (e.g., N-acetylcysteine).
• Refractory cases benefit from autologous serum tears, punctal occlusion, bandage contact lenses, amniotic membrane transplantation, or tarsorrhaphy.

Conclusions:

• Filamentary keratitis is a multifactorial, recurrent condition needing personalized treatment.
• Early diagnosis and multimodal management are crucial for symptom relief and preventing further ocular surface damage.
• New therapies and surgical options improve outcomes for difficult-to-treat cases.