Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
OtherPractice

Answer: Can you identify this condition?

David Ehmann, Kelly D. Schweitzer and Stephanie Baxter
Canadian Family Physician July 2010; 56 (7) 673;
David Ehmann
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kelly D. Schweitzer
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephanie Baxter
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Answer to Ophthaproblem continued from page 667

2. Filamentary keratitis

Filamentary keratitis (FK) is a relatively uncommon disorder1–3 characterized by the presence of corneal filaments (Figure 1),3 which are fine strands of degenerated epithelial cells and mucous attached to the cornea.1,2,4 It can be chronic and debilitating, with recurrent exacerbations.1,5

Figure 1.
  • Download figure
  • Open in new tab
Figure 1.
  • Download figure
  • Open in new tab
Figure 1.

Corneal filament viewed with normal and cobalt blue light after fluorescein staining

Patients often present with discomfort, photophobia,3 foreign body sensation, blurred vision,1 grittiness, blepharospasm, and increased blinking.2,5 Signs include decreased corneal sensation, corneal filaments, mucous debris, redness, 1 superficial punctate keratopathy, and punctate epithelial erosions, as well as abnormal tear break-up time and Schirmer test results.5 Impression cytology of the conjunctiva might reveal squamous metaplasia and reduced goblet cell density with inflammatory cell infiltrates.1 The size and shape of corneal filaments might vary and, with time, become fatter, longer, and more twisted owing to mechanical forces of the eyelids.1,2,5 They stain best with rose bengal dye and less well with fluorescein.2,5

Filamentary keratitis can be a functionally debilitating and sight-threatening complication of a number of systemic and ocular conditions,1 most commonly the aqueous-deficient dry eye conditions, also known as keratoconjunctivitis sicca (KCS).1 Both the autoimmune (Sjögren syndrome) and nonautoimmune forms of aqueous-deficient dry eye can feature corneal filaments.1 Kowalik and Rakes reported that 95% of corneal filaments were secondary to KCS and that evidence of rheumatologic disease was present in 75% of patients with KCS.2 Superior limbic keratoconjunctivitis is the second most common disease associated with corneal filaments; as many as 50% of patients develop FK during the course of their disease.2 Other conditions associated with FK include exposure keratitis; corneal edema; postcataract, corneal, or refractive surgery; and contact lens use.1–5 Less often, FK is associated with acne rosacea and adenoviral, herpetic, and bacterial keratitis.2 Systemic medications such as diuretics and antihistamines are capable of altering aqueous tear and mucous production, and have been associated with FK.5 Filaments might also result from extended eyelid closure secondary to medications, extended patching, or psychiatric conditions.

The exact pathogenesis of FK is unclear.1,4 Zaidman et al4 hypothesized that an underlying process damages the basal corneal epithelium, basement membrane, or Bowman layer, leading to focal areas of basement membrane detachment. With time and mechanical shearing of the eyelids, these areas become elevated and act as receptor sites for mucous and degenerated epithelial cells. Once established, corneal filaments are firmly attached to the underlying epithelium and the friction between them and the upper lid results in epithelial tears, pain, and inflammation, leading to further filament formation.2,4,5

Management

For some, FK can be managed with preservative-free artificial tears.2,5 In other cases, several treatments might be required. Debridement of filaments might cause swift relief of symptoms, but it is important to treat the underlying disease when possible.1,2,5 Other options include mucolytic agents, hypertonic saline, topical nonsteroidal anti-inflammatory drugs, topical steroids, punctual plugs, and bandage contact lenses.1,2,5 Judicious use of topical medications is important, as the cornea is more susceptible to the intrinsic and preservative toxicities of the medications. 1 Topical steroids should be reserved for acute exacerbations, as overuse can lead to cataract formation and increased intraocular pressure.1,5 Short-term treatment with soft contact lenses is beneficial to allow the basal epithelial cells to re-attach to the basement membrane.2,4,5 It is important to treat concomitant ocular surface problems such as meibomitis1 with warm compresses, eyelid margin hygiene, and in severe cases oral tetracyclines.

Patient education and counseling are crucial for long-term management.1,5 Many of the underlying etiologies have no cures, and patients should be prepared to incorporate a maintenance regimen into their daily routines.5 Acute exacerbations are common, and regular follow-up visits might be necessary to ensure vision is preserved.5

Our patient was treated with acetylcysteine eye drops 4 times daily for 2 weeks, combined with 5 minutes of warm compresses twice daily to promote proper eyelid margin meibomian gland function. Symptoms and corneal filaments resolved without debridement. She uses an ocular lubricant and warm compresses to prevent recurrence.

Conclusion

Filamentary keratitis is relatively uncommon but has potentially sight-threatening consequences.1 Thorough systemic examination and hematologic workup are important in chronic cases to investigate for conditions such as Sjögren syndrome, rheumatoid arthritis, and thyroid disease.5

Acknowledgments

We thank Patricia Pauls for taking the photographs used in this article.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Albietz J,
    2. Sanfilippo P,
    3. Troutbeck R,
    4. Lenton LM
    . Management of filamentary keratitis associated with aqueous-deficient dry eye. Optom Vis Sci 2003;80(6):420-30.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Kowalik B,
    2. Rakes J
    . Filamentary keratitis—the clinical challenges. J Am Optom Assoc 1991;62(3):200-4.
    OpenUrlPubMed
  3. ↵
    1. Tabery HM
    . Filamentary keratopathy: a non-contact photomicrographic in vivo study in the human cornea. Eur J Ophthalmol 2003;13(7):599-605.
    OpenUrlPubMed
  4. ↵
    1. Zaidman GW,
    2. Geeraets R,
    3. Paylor RR,
    4. Ferry AP
    . The histopathology of filamentary keratitis. Arch Ophthalmol 1985;103(8):1178-81.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Diller R,
    2. Sant S
    . A case report and review of filamentary keratitis. Optometry 2005;76(1):30-6.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 56 (7)
Canadian Family Physician
Vol. 56, Issue 7
1 Jul 2010
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Answer: Can you identify this condition?
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Answer: Can you identify this condition?
David Ehmann, Kelly D. Schweitzer, Stephanie Baxter
Canadian Family Physician Jul 2010, 56 (7) 673;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Answer: Can you identify this condition?
David Ehmann, Kelly D. Schweitzer, Stephanie Baxter
Canadian Family Physician Jul 2010, 56 (7) 673;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • 2. Filamentary keratitis
    • Management
    • Conclusion
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • Question: Can you identify this condition?
  • Question: Can you identify this condition?
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Effectiveness of dermoscopy in skin cancer diagnosis
  • Spontaneous pneumothorax in children
  • Is 45 the new 50 in colorectal cancer screening?
Show more Practice

Ophthaproblem

  • Question: Can you identify this condition?
  • Answer: Can you identify this condition?
  • Question: Can you identify this condition?
Show more Ophthaproblem

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire