Corneal endotheliitis

Corneal endotheliitis is a rare inflammatory condition of the eye that specifically targets the corneal endothelium — the innermost single-cell layer of the cornea responsible for maintaining corneal clarity by regulating fluid balance. The disease is characterized by corneal edema (swelling), keratic precipitates (inflammatory deposits on the inner corneal surface), and mild anterior chamber inflammation. Patients typically present with blurred vision, eye redness, and discomfort, often unilaterally, though bilateral involvement can occur. The condition is frequently associated with viral infections, particularly herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV), which are believed to trigger an immune-mediated inflammatory response against the endothelial cells. Three clinical patterns have been described: disciform, diffuse, and linear endotheliitis, each with distinct distributions of keratic precipitates and corneal edema. Disciform endotheliitis presents with a central disc-shaped area of edema, linear endotheliitis shows a progressive line of keratic precipitates, and diffuse endotheliitis involves widespread endothelial inflammation. If left untreated, chronic or recurrent episodes can lead to permanent endothelial cell loss and irreversible corneal decompensation requiring corneal transplantation. Treatment typically involves a combination of topical corticosteroids to control inflammation and antiviral therapy (such as acyclovir, valacyclovir, or ganciclovir, depending on the suspected viral etiology) to address the underlying infectious trigger. In CMV-associated cases, topical ganciclovir has shown particular efficacy. Early diagnosis and prompt treatment are essential to preserve endothelial cell density and maintain corneal transparency. Recurrences are common, and some patients may require long-term low-dose antiviral prophylaxis to prevent further episodes of inflammation and progressive endothelial cell loss.

Common questions about Corneal endotheliitis