A 43-year-old male presents to your clinic complaining of a six month history of increasing ocular irritation. He complains of intermittent burning and grittiness for years, but says the symptoms have become much worse lately.
On exam visual acuities are 20/25 bilaterally with normal intraocular pressures. On slit lamp examination whitish strands are seen on the surface of the cornea (see below).
The patient's presentation is consistent with which of the following?
The appearance in the photo is not in keeping with pseudodendrites.
There is no history of contact lens wear. In addition, there are no signs on anterior segment exam of contact lens overwear such as peripheral neovascularization or subepithelial infiltrates.
Although meibomian gland dysfunction is a major cause of dry eye, it would not be responsible for the patient's subacute presentation with corneal filaments.
A complication that can occur in patients with moderate-severe dry eye. Filamentary keratitis is characterized by filaments and mucous plaques on the cornea. More discussion within this course.
Dry eye, also known as keratoconjunctivitis sicca, is an extremely common condition encountered by eye care professionals. Its official NEI Workshop definition is “a disorder of the tear film due to tear deficiency or excessive tear evaporation which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort”. 1 Likely underdiagnosed, its reported prevalence ranges from 5-30%, increasing with age.2, 3 It affects roughly 15% of those over the age of 65.
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