Strands composed of degenerated epithelial cells and mucus develop and adhere to the corneal surface causing foreign body sensation & pain
● Aqueous tear deficiency - KCS
● Corneal exposure (seventh nerve palsy)
● Occlusion abnormalities - blepharoptosis
● Ocular surgery (keratoplasty)
● Systemic diseases with effects on the ocular surface (Sjogren’s syndrome)
● Extended use of anticholinergic medications
● Other ocular surface abnormalities.
● Increase in tear film mucus to aqueous ratio (decrease in aqueous tear production/ increased production or accumulation of the mucinous component) -> formation of mucoid filaments
● They adhere to small defects on corneal epithelium
● Mucin attaches to epithelial defect and loose epithelial strands are incooperated
into mucin strand attached to the surface
● Initial step - damage to basal epithelial
cells, epithelial basement membrane, or Bowman’s layer -> focal
detachments of epithelial basement membrane
● Blinking - areas of detachment to become elevated -> to irritation,
inflammation, and increased mucus production
● Sites of epithelial damage provide the scaffold for filaments to develop
● Mild to severe foreign body sensation exacerbated by blinking
● Photophobia, blepharospasm, epiphora
● Multiple filamentary attachments firmly adherent to the corneal surface 0.5-10mm
● Decreased aqueous tears
● Increased mucin in the precorneal tear film
● Subepithelial opacities at the base of filaments
● Blinking causes traction on the filaments and detach them leaving behind an
● Filaments stain with Rose Bengal and Fluorescein.
Management of underlying conditions like dry eye syndromes, medication toxicity, contact lens overuse, blepharoptosis.
● Topical lubricants and ointment
● Bandage contact lens
● Mucolytic agent – N- Acetylcysteine
● Topical Nacl drops. Removed at slit lamp using jeweler’s forceps - avoid disrupting the epithelium at base of filament.
𝘊𝘰𝘮𝘱𝘭𝘪𝘤𝘢𝘵𝘪𝘰𝘯𝘴: Infectious Keratitis
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