eMedicine Specialties > Ophthalmology > Cornea

Keratitis, Interstitial: Differential Diagnoses & Workup

Author: Parag A Majmudar, MD, Fellowship Co-Director, Department of Ophthalmology, Cornea and Refractive Surgery Service, Assistant Professor, Rush-Presbyterian-St Luke's Medical Center
Contributor Information and Disclosures

Updated: Dec 14, 2007

Differential Diagnoses

Keratitis, Bacterial
Keratitis, Fungal
Keratitis, Herpes Simplex
Keratoconjunctivitis, Atopic

Other Problems to Be Considered

Corneal dystrophies
Metabolic corneal disorders
Cogan syndrome

Workup

Laboratory Studies

  • A diagnosis of syphilitic IK is often based on the clinical findings and by serologic testing.
    • Other nonocular findings of syphilis may be helpful in establishing the diagnosis of syphilis. These include dental abnormalities (Hutchinson teeth), facial asymmetry, saddle-nose deformity, saber shins, deafness, and mental retardation.
    • Serologic testing of syphilis can be performed by a treponemal test and nontreponemal test. The treponemal test detects immunoglobulin to Treponema pallidum. The two treponemal tests are the fluorescent treponemal antibodies absorption (FTA-ABS) test and the microhemagglutination-T pallidum (MHA-TP) test. These tests always remain positive once an exposure to the causative agent of syphilis has occurred. In contrast, the nontreponemal test detects immunoglobulin to phospholipids (anticardiolipin antibodies); these are nonspecific tests, and the titers will decrease once adequate treatment has been initiated. The two most commonly used nontreponemal tests include the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR).
  • To diagnose tuberculosis, a purified protein derivative (PPD) test with anergy panel should be placed. Lyme titers and enzyme-linked immunosorbent assay (ELISA) may be helpful in establishing the diagnosis of Lyme disease.
  • Serologic testing may assist in the diagnosis of Cogan syndrome, although this remains largely a diagnosis of exclusion. Lymphocytosis and an elevated erythrocyte sedimentation rate (ESR) have been described in those patients with an active systemic vasculitis. There have been variable reports of human leukocyte antigen B17 (HLA-B17) more prevalent in patients with Cogan syndrome, although the results are equivocal.

More on Keratitis, Interstitial

Overview: Keratitis, Interstitial
Differential Diagnoses & Workup: Keratitis, Interstitial
Treatment & Medication: Keratitis, Interstitial
Follow-up: Keratitis, Interstitial
References
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References

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  2. Cogan DG, Dickersin GR. Nonsyphilitic interstitial keratitis with vestibuloauditory symptoms. A case with fatal aortitis. Arch Ophthalmol. Feb 1964;71:172-5. [Medline].

  3. Cogan DS. Syndrome of nonsyphilitic interstitial keratitis and vestibuloauditory symptoms. Arch Ophthalmol. 1945;33:144-9.

  4. Dekkers NW, Treskes M. Measles keratitis. Ophthalmol Clin North Am. 1994;74:574.

  5. Dinis da Gama R, Cidade M. Images in clinical medicine. Interstitial keratitis as the initial expression of syphilitic reactivation. N Engl J Med. Jun 6 2002;346(23):1799. [Medline].

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  7. Goegebuer A, Ajay L, Claerhout I, Kestelyn P. Results of penetrating keratoplasty in syphilitic interstitial keratitis. Bull Soc Belge Ophtalmol. 2003;(290):35-9. [Medline].

  8. Helm CJ, Holland GN. Ocular tuberculosis. Surv Ophthalmol. Nov-Dec 1993;38(3):229-56. [Medline].

  9. Jones BR, McGill JI, Steele AD. Recurrent suppurative kerato-uveitis with loss of eye due to infection by Acanthamoeba castellani. Trans Ophthalmol Soc U K. Jul 1975;95(2):210-3. [Medline].

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  14. Norton EW, Cogan DG. Syndrome of nonsyphilitic interstitial keratitis and vestibuloauditory symptoms; a long-term follow-up. AMA Arch Ophthalmol. May 1959;61(5):695-7. [Medline].

  15. Orsoni JG, Zavota L, Manzotti F, Gonzales S. Syphilitic interstitial keratitis: treatment with immunosuppressive drug combination therapy. Cornea. Jul 2004;23(5):530-2. [Medline].

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  17. Rabb MF, Fine M. Penetrating keratoplasty in interstitial keratitis. Am J Ophthalmol. Jun 1969;67(6):907-17. [Medline].

  18. Roizenblatt J. Interstitial keratitis caused by American (mucocutaneous) leishmaniasis. Am J Ophthalmol. Feb 1979;87(2):175-9. [Medline].

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  20. Taylor HR, Semba RD, Newland HS, Keyvan-Larijani E, White A, Dukuly Z, et al. Ivermectin treatment of patients with severe ocular onchocerciasis. Am J Trop Med Hyg. May 1989;40(5):494-500. [Medline].

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Further Reading

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Keywords

interstitial keratitis, IK, syphilitic keratitis, Cogan syndrome, syphilitic disease, syphilis, herpes

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Contributor Information and Disclosures

Author

Parag A Majmudar, MD, Fellowship Co-Director, Department of Ophthalmology, Cornea and Refractive Surgery Service, Assistant Professor, Rush-Presbyterian-St Luke's Medical Center
Parag A Majmudar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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