What Is Endotheliitis Eye?
Endotheliitis eye refers to the inflammation of the corneal endothelium, which is the innermost layer of cells of the cornea. This inflammation can disrupt the normal function of these vital cells, leading to the accumulation of fluid in the cornea (corneal edema) and subsequent changes in vision.
Understanding Corneal Endotheliitis
The cornea is the transparent, outermost layer of the eye that helps focus light. Its clarity is crucial for good vision. The corneal endothelium plays a critical role in maintaining this clarity by actively pumping excess fluid out of the corneal stroma, preventing swelling.
When endotheliitis occurs, the inflamed endothelial cells become dysfunctional. They lose their ability to effectively regulate corneal hydration, causing fluid to build up. This swelling, known as corneal edema, can lead to:
- Blurred vision: The swollen cornea scatters light.
- Glare and halos: Due to irregular light refraction.
- Reduced visual acuity: Overall decrease in sharpness of vision.
The Role of the Corneal Endothelium
The corneal endothelium is a single layer of hexagonal cells that lines the posterior surface of the cornea. Its primary functions include:
- Barrier function: Preventing the leakage of aqueous humor from the anterior chamber into the corneal stroma.
- Pump function: Actively transporting fluid out of the stroma, maintaining corneal deturgescence (a state of relative dehydration that ensures transparency).
Damage or inflammation to these cells, as seen in endotheliitis, compromises these functions, leading to corneal opacification.
Causes of Endotheliitis
Endotheliitis can arise from various etiologies, including infections, immune responses, and sometimes, surgical complications. Identifying the specific cause is crucial for effective treatment.
| Common Causes of Endotheliitis | Description |
|---|---|
| Viral Infections | Often the most common cause. Viruses like Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV) (which causes chickenpox and shingles), and Cytomegalovirus (CMV) can directly infect and damage endothelial cells. |
| Immune-mediated Reactions | Sometimes, the body's own immune system can target the endothelial cells, either as a primary autoimmune condition or in response to an unidentified trigger. |
| Post-Surgical Complications | Though less common, endotheliitis can occasionally occur after certain intraocular surgeries, possibly due to inflammation or mechanical trauma during the procedure. |
| Other Inflammatory Conditions | Rarely, it might be associated with other inflammatory conditions within the eye (e.g., uveitis). |
Symptoms and Diagnosis
Recognizing the symptoms of endotheliitis early is important for prompt medical attention. Common signs and symptoms include:
- Gradual or sudden blurring of vision
- Seeing halos around lights
- Increased sensitivity to light (photophobia)
- Mild to moderate eye pain or discomfort
- Redness of the eye (less common but can occur with severe inflammation)
Diagnosis of endotheliitis typically involves a comprehensive eye examination by an ophthalmologist using several diagnostic criteria:
- Slit-Lamp Examination: A high-magnification microscope allows the doctor to visualize the corneal layers, identify inflammation signs like keratic precipitates (inflammatory cells adhering to the endothelium), and assess corneal edema.
- Pachymetry: Measures the thickness of the cornea, confirming the presence and extent of edema.
- Confocal Microscopy: A specialized imaging technique that can visualize individual endothelial cells, assessing their health, density, and morphology. This helps differentiate endotheliitis from other corneal conditions.
- Aqueous Humor Analysis: In some cases, a small sample of fluid from the eye (aqueous humor) may be taken to test for the presence of viral DNA, helping to identify the causative agent.
Treatment Approaches
Treatment modalities for endotheliitis aim to reduce inflammation, clear the viral infection (if present), and prevent permanent damage to the corneal endothelium. The specific approach depends on the underlying cause:
- Antiviral Medications: If a viral infection (e.g., HSV, VZV, CMV) is identified or suspected, oral or topical antiviral drugs are prescribed to suppress the virus and reduce its activity.
- Corticosteroids: Topical steroid eye drops are often used to reduce inflammation and minimize corneal edema. In severe cases, oral steroids may be considered. These need to be used carefully under medical supervision due to potential side effects like increased intraocular pressure.
- Corneal Dehydration Measures: Hypertonic saline drops or ointments might be used to help draw fluid out of the cornea, reducing edema and improving vision temporarily.
- Surgical Intervention: In chronic or severe cases where significant endothelial cell loss has occurred and vision is permanently impaired due to persistent edema, a corneal transplant (e.g., Descemet's Stripping Endothelial Keratoplasty - DSEK or DMEK) may be necessary to replace the damaged endothelial layer.
Early and accurate diagnosis combined with appropriate treatment is essential to manage endotheliitis effectively and preserve long-term vision.
