Non-infectious

• Definition: corneal epithelial damage caused by severe UV light radiation with pronounced pain symptomatology

• Etiology

  • Welding without proper protective eye wear

  • Associated with cosmetic tanning (tanning bed)

  • High levels of UV radiation in high-altitude mountain regions without UV-protective eyewear

• Pathophysiology

  • Necrosis of the corneal epithelial cells → inflammatory reactions, edema, and epithelial cell shedding

  • Symptoms appear after a latent period of approx. 6–8 h

• Clinical features

  • Epithelial damage is initially often asymptomatic

  • Severe pain

  • Photophobia

  • Foreign body sensation

  • Blepharospasm

  • Epiphora

  • Decreased visual acuity

• Diagnostics

  • Bilateral multiple, fine-spotted, superficial, fluorescein-positive corneal epithelial lesions (Thygeson superficial punctate keratopathy)

  • Conjunctival vessel injection

• Treatment

  • Patient briefing

  • Antibiotic eye ointment

  • Immobilization

  • Oral analgesics

• Complications: risk of infection

• Prognosis: usually complete recovery after 24–48 h

Exposure keratopathy

• Definition: keratitis caused by the inability to completely close the eyelids resulting in corneal drying

• Etiology: mainly caused by damage to the facial nerve, e.g., from a stroke

Neurotrophic keratopathy

• Definition: keratitis as a result of corneal sensory loss due to paralysis of the 1st trigeminal branch

• Etiology

  • Nerve damage

  • Tumor in the nerve path region

  • Chronic herpes infection

• Clinical features

  • Decreased vision; dry eye

  • Early stage: absent corneal reflex; decreased tear break-up time; dry spots on corneal surface

  • Late stage: central circular/oval nonhealing corneal ulcer

  • Complication: corneal perforation

• Treatment

  • Early stage: artificial tears

  • Late stage: prophylactic antibiotic drops; tarsorrhaphy ; amniotic membrane transplantation and conjunctival flap