Predisposing factors of infectious keratitis in chronic cicatrizing conjunctivitis

To review the multifactorial predisposing factors to infectious keratitis (IK) in patients with chronic cicatrizing conjunctivitis (CCC), and to highlight diagnostic challenges and preventive strategies in this high-risk population.

Literature review.

IK in CCC arises from an interplay of mechanical-anatomical, immunological, and microbiological factors. Key contributors include lid malposition, persistent epithelial defects, tear film instability, use of contact lenses or keratoprostheses, altered microbiome, and long-term immunosuppressive therapy. Staphylococcus aureus, coagulase-negative staphylococci, Corynebacterium spp., Herpesviridae, and Candida spp. are the most common causal organisms. Infections are often polymicrobial and drug-resistant, and may present atypically due to corneal hypoesthesia, tear-film instability, aqueous tear deficiency, and scarring. Diagnosis is frequently delayed, increasing the risk of corneal melting and perforation. Preventive strategies include eyelid reconstruction, cautious use of ocular devices, prophylactic antibiotics, periodical microbiological testing, and early recognition of subtle clinical signs.

Patients with CCC face a heightened risk of IK due to profound ocular surface disruption. Understanding the specific predisposing factors and implementing tailored preventive and therapeutic approaches are essential to minimizing vision-threatening complications in this vulnerable population.