Beyond the surface: a comprehensive review of corneal endotheliitis

Corneal endotheliitis can present with various manifestations, including corneal edema, keratic precipitates, anterior chamber reaction, limbal injection, neovascularization, and elevated intraocular pressure. Several infectious (i.e., viruses, bacteria, fungi) and non-infectious factors (i.e., iatrogenic, systemic diseases, and medications) can contribute to the development of corneal endotheliitis. The anterior chamber-associated immune deviation mechanism is suggested to be activated in the condition. Herein, suppression of cell-mediated immunity may facilitate the proliferation of pathogens, e.g., viruses, within the corneal endothelium, impairing the cells' function and resulting in edema. Treatment options vary due to the exact etiology of the disease; depending on this, steroids, antiviral medications, antibiotics, or antifungals can be prescribed.Accurate and prompt identification of the underlying etiology is crucial in the management of the disease and in achieving optimal visual outcomes. Ophthalmologists should maintain a broad differential diagnosis for patients with suspected endotheliitis and use appropriate diagnostic and therapeutic strategies. Furthermore, future research should unravel the pathophysiological mechanism associated with this condition.