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Ophthalmology and Visual Sciences

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Infectious Crystalline Keratopathy

Photographer: Antoinette Venckus, CRA; Photomicrographs by Nasreen Syed, MD

Contributor(s): Lauren E. Hock, MD and Mark A. Greiner, MD

Posted February 25, 2019

This 73-year-old male patient presented to the Cornea service with a one-week history of right eye redness and pain. He had a remote history of open globe with multiple subsequent penetrating keratoplasties and a recent macula-involving retinal detachment all in the right eye with resulting hand motions vision. He was diagnosed with suture-related infectious crystalline keratopathy with associated epithelialized stromal melt. The dense crystals seen within the deep stroma represent arborizing aggregates of an infectious agent, often alpha-hemolytic streptococcus or Candida albicans, and often originating from a suture track. Microbial colonies proliferate within stromal lamellar spaces and are shielded by a biofilm [1]. Corneal cultures are often negative. Lack of host inflammatory response may be due to chronic immunosuppression, tear film irregularity, or suture [2].  

Please see related case for further information and discussion regarding treatment.

Slit lamp photograph of the right eye shows mild injection, penetrating keratoplasty graft with 1 x 1 mm epithelialized melt with white crystalline infiltrate sprouted within stroma extending 2.5 mm x 2.5 mm and large keratic precipitates posterior to involved area.

Figure 1. Slit lamp photograph of the right eye shows mild injection, penetrating keratoplasty graft with 1 x 1 mm epithelialized melt with white crystalline infiltrate sprouted within stroma extending 2.5 mm x 2.5 mm and large keratic precipitates posterior to involved area. Patient was also noted to have central striae, stromal edema, and Descemet's folds with no cell, 1+ flare, and inferonasal membranes along endothelium and iris. Corneal scraping was negative.

Figure 2. Lower power photomicrograph (H&E stain, original magnification = 50x) of cornea demonstrates sequestrations of basophilic granular material (arrows) within the corneal stroma adjacent to a previous penetrating keratoplasty wound.

High power photomicrograph (Gram stain, original magnification = 200x) shows presence of gram positive cocci in the sequestrations without appreciable surrounding inflammation.

Figure 3. High power photomicrograph (Gram stain, original magnification = 200x) shows presence of gram positive cocci in the sequestrations without appreciable surrounding inflammation.

References

  1. Porter AJ, Lee GA, Jun AS. Infectious crystalline keratopathy. Surv Ophthalmol 2018;63(4):480-499.  https://PubMed.gov/29097211. DOI: 10.1016/j.survophthal.2017.10.008
  2. Mannis MJ, Holland EJ. Cornea. Fourth edition. ed.

Contributor: Matt Ward, MD, The University of Iowa

Category: Cornea/External Eye Disease

Posted October 5, 2012

This an indolent corneal infection classically occuring in the absence of an epithelial defect in corneal transplants on chronic steroid therapy. It has a frost-like crystalline pattern. It is typically caused by alpha-hemolytic streptococcus species such as Viridans. In this case, this patient was on chronic mild steroid drops (fluormethalone) for treatment of severe, recalcitrant blepharitis and ocular surface disease. ICK is difficult to treat medically and may require debridement either by hand or with an excimer laser.

Infectious crystalline keratopathy


Contributor: Andrew Doan, MD, PhD, University of Iowa

Category: Cornea

Posted February 8, 2008

Infectious crystalline keratopathy in corneal transplant graft. Often strep viridans is the culprit.

Infectious crystalline keratopathy


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last updated: 2/25/2019
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