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Filamentary Keratitis: A Persistent Challenge in Ocular Surface Disease
Gustavo Ortiz-Morales1, Maria Cristina Nordmann-Gomes1, Mariana Navarrete-Azuara1
1Department of Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico.
Purpose:
To provide a comprehensive overview of filamentary keratitis (FK), its pathophysiology, associated conditions, clinical manifestations, and current management strategies.
Methods:
A narrative review of the literature describing the etiopathogenesis, clinical features, and therapeutic approaches for FK. Emphasis was placed on conventional treatments, advanced medical therapies, and surgical interventions used in refractory cases.
Results:
FK is a chronic ocular surface disorder marked by the presence of mucus-epithelial filaments adhered to the cornea, frequently associated with dry eye disease, autoimmune disorders, and neurotrophic or exposure keratopathies. Its pathogenesis involves tear film instability, excessive mucus production, and mechanical trauma from blinking. Management remains challenging due to high recurrence rates. Standard treatments include lubrication, mechanical debridement, topical corticosteroids, and mucolytics such as N-acetylcysteine. In severe or refractory cases, autologous serum tears, punctal occlusion, bandage contact lenses, and surgical procedures like amniotic membrane transplantation or tarsorrhaphy are effective in stabilizing the ocular surface and reducing symptoms.
Conclusion:
FK is a multifactorial and recurrent disease that requires a tailored therapeutic approach. Early recognition and multimodal management are essential for symptom control and prevention of further ocular surface damage. Emerging therapies and surgical options expand the armamentarium for treating refractory cases, improving patient outcomes.
Insights
Filamentary keratitis (FK) involves corneal filaments and often co-occurs with dry eye. Management requires tailored, multimodal approaches to control symptoms and prevent ocular surface damage.
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.
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