Infectious crystalline keratopathy

Abstract

Abstract Purpose To provide the definition, clinical features, diagnosis and management of infectious crystalline keratopathy (ICK). Methods Personal experience, experimental study on ex‐vivo ICK and literature review Results ICK can be defined as microbial infection of the cornea in the absence of the host immune response. It can be caused by a variety of microbes including bacteria and fungi. It is characterised by corneal infiltrates in the form of branching or arborescent patterns of needles, snowflakes or fern shapes. This pattern is determined by the compactness of the corneal lamellae. Clinically there is minimal host inflammatory response although there can be areas of suppuration remote from the ICK. The epithelium is usually intact, symptoms are mild and it runs a chronic indolent course. Corneal hypoesthesia and corticosteroid use are risk factors. Diagnosis is based upon clinical examination in conjunction with careful history taking. The presence of branching crystalline deposits located in the stroma often near suture sites and following corneal surgery should raise suspicion. Intensive topical antibiotics, keratectomy of the affected site to excise lesion if possible, cessation of steroid medication or repeat corneal graft are aspects of management of ICK. Conclusion ICK is a rare but difficult to treat condition. Diagnosis is based on history and clinical features. Sample (scrape) or biopsy can be taken for culture and sensitivity of organisms involved. Treatment is difficult and surgery may be required to eliminate the infected locus. Commercial interest