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Filaments on cornea! ⁣

⁣𝗙𝗶𝗹𝗮𝗺𝗲𝗻𝘁𝗮𝗿𝘆 𝗞𝗲𝗿𝗮𝘁𝗶𝘁𝗶𝘀⁣

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⁣

epithelial defect⁣

● 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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