Infectious Crystalline Keratopathy (ICK)

Infectious crystalline keratopathy (ICK) is a rare, slow-growing infection of the cornea. It was first described in 1983 by Gorovoy and colleagues after they saw tiny, needle-like bacteria colonies in a patient’s cornea following a corneal transplant. Unlike other infections, ICK causes little redness or pain at first, because the infection stays in the deeper layers of the cornea and forms a sticky biofilm that hides it from the immune system. This biofilm also makes it hard for antibiotics to reach the germs and for doctors to grow the germs in a lab test. As a result, ICK can quietly damage vision over months or years before it is found PubMed+1.

Infectious crystalline keratopathy (ICK) is a rare, slowly progressive infection of the corneal stroma characterized by fine, needle-like or fern-like branching opacities with minimal surrounding inflammation. Patients often present with whitish, snowflake-like crystalline deposits within a clear or mildly hazy graft or corneal tissue, leading to gradual vision decline without the intense redness or pain typical of other keratitides EyeWiki. ICK most commonly follows penetrating keratoplasty or prolonged topical corticosteroid use, which create an immunocompromised corneal environment that allows organisms—most often α-hemolytic Streptococcus viridans—to invade interlamellar spaces and secrete a protective polysaccharide biofilm EyeWikiWiley Online Library. This biofilm hinders both host immune responses and antibiotic penetration, accounting for the disease’s indolent course and treatment challenges.

Types

The main kinds of ICK are grouped by which germ causes the infection:

1. Bacterial ICK
Most often, ICK is caused by bacteria, especially alpha-hemolytic Streptococcus bacteria. These bacteria grow in branching, crystal-like patterns between layers of the cornea, making whitish lines that look like frost or broken glass. Because these bacteria make a biofilm, they stay hidden with little inflammation, so the eye may look nearly normal for a long time WebEye.

2. Fungal ICK
In some cases, fungi such as Candida or Alternaria species grow in a similar way. Fungal ICK also has needle-like or branching patterns but may appear grayish or brownish. These infections are even harder to treat because fungi live deep in the cornea and resist many medicines WebEye.

3. Mixed ICK
Sometimes, more than one type of germ is involved. A mixed infection can include both bacteria and fungi living together in a biofilm. Mixed ICK often shows varied colors and shapes of crystals and can be the hardest to clear because treatment must target different organisms at once WebEye.

 Causes

Below are twenty factors that can lead to ICK. Each one explains why it raises the risk:

1. Penetrating Keratoplasty Surgery
   A full-thickness corneal transplant can leave tiny gaps or scars where germs can hide. When bacteria stick to these areas, they form biofilms and slowly eat away at the cornea PubMed.

2. Topical Corticosteroid Use
   Steroid eye drops reduce inflammation but also lower local immunity. Germs take advantage of this weaker defense to grow without causing strong redness or pain PubMed.

3. Systemic Immunosuppression
   People on medicines like chemotherapy or after organ transplant have weaker overall immunity. Their eyes cannot fight off germs as well, allowing ICK to develop quietly PubMed.

4. Large Corneal Graft Size
   Bigger corneal transplants have more stitches and wound edges. Each stitch is a potential entry point for germs to hide and form a biofilm PubMed.

5. Poor Ocular Surface Health
   Chronic dry eye, blepharitis, or allergic conjunctivitis make the surface of the eye irregular. Germs cling more easily to rough, dry areas and set up infection Cleveland Clinic.

6. Chronic Dry Eye
   When tears do not cover the cornea evenly, germs are not washed away. Dry patches allow bacteria or fungi to stick and grow in a biofilm.

7. Contact Lens Wear
   Soft lenses can trap germs against the cornea and scratch the surface slightly, giving an easy gateway for infection.

8. Blepharitis
   Inflammation of the eyelid edges leads to clogged glands and oily debris on the eye. This debris feeds bacteria that can migrate into the cornea.

9. Previous Corneal Infection
   Any past corneal ulcer or infection may leave scarring or thinning. Germs can return more easily to these weakened spots.

10. Ocular Trauma
    Cuts or scratches from fingernails, dust, or foreign bodies break the corneal surface. Germs slip inside and form protected biofilms.

11. Chronic Ocular Inflammation
    Conditions like rheumatoid arthritis can cause ongoing inflammation and tiny breaks in the cornea, inviting infection.

12. Diabetes Mellitus
    High blood sugar damages small blood vessels and nerves around the eye, reducing tear quality and immune response on the cornea.

13. Age (Older Adults)
    As people age, tear production and immune function decline, and the cornea heals more slowly, giving germs time to settle.

14. Biofilm Formation
    Some germs naturally produce sticky substances that bind them together. Once a biofilm forms, infections become chronic and hidden.

15. Inadequate Antibiotic Penetration
    The biofilm and deep corneal layers block many antibiotics, so low-strength drops may never reach the germs.

16. Use of Preservative-Containing Eye Drops
    Preservatives can irritate the cornea over time and disrupt the normal tear film, allowing germs to latch on.

17. Corneal Suture Presence
    Sutures left in place too long can erode tiny tunnels in the cornea, making safe harbors for germs.

18. Neurotrophic Keratopathy
    Nerve damage from surgeries or infections reduces corneal sensation. Painless scratches go unnoticed and untreated, allowing germs to grow.

19. Ocular Cicatricial Pemphigoid
    This autoimmune disease scars the conjunctiva and lid, leading to dry, rough corneas where germs thrive.

20. Inadequate Hygiene
    Touching the eyes with unwashed hands or reusing old eye drops can introduce new germs to an already vulnerable cornea.

Symptoms

Patients with ICK may notice the following symptoms, often starting very mildly and worsening over time:

1. Mild Eye Discomfort
   At first, patients may only feel a slight ache or scratchiness, as deep germ growth causes little surface irritation EyeWiki.

2. Severe Eye Pain
   Over months, the infection can spread closer to the surface, causing sharp or throbbing pain.

3. Blurred Vision
   As crystalline deposits form, light scatters inside the cornea, making objects look fuzzy.

4. Photophobia (Light Sensitivity)
   Bright lights may feel glaring or painful because the corneal crystals reflect and bend light unevenly EyeWiki.

5. Eye Redness
   Unlike typical infections, redness may remain mild or come late, due to low inflammation.

6. Tearing (Epiphora)
   The eye may water more than usual as a reflex to irritation.

7. Foreign Body Sensation
   Patients describe feeling like there is sand or grit in the eye.

8. Minimal Discharge
   ICK often produces little to no pus or mucus, because the infection stays beneath the surface.

9. Visible Stromal Crystals
   Under a slit lamp, doctors see thin, branching, whitish lines in the cornea.

10. Branching Needle-Like Opacities
    The crystals often form a branching “tree-like” pattern that is characteristic of ICK PubMed.

11. Gray or White Opacities
    Depending on the organism, crystals may appear pure white or slightly grayish.

12. Indolent Course
    Symptoms worsen very slowly, over weeks to years, unlike acute keratitis that spikes quickly.

13. Minimal Inflammation
    The cornea may stay surprisingly clear around the crystals, with only mild redness.

14. Decreased Visual Acuity
    Patients often report gradual loss of sharpness in vision.

15. Asymptomatic Early Stage
    In the earliest phase, many people notice no symptoms at all and only find ICK during a routine eye exam.

Diagnostic Tests

Below are twenty tests grouped by category. Each test helps doctors confirm ICK and plan treatment.

Physical Examination Tests

1. Visual Acuity Testing
   This simple chart test measures how clearly a patient can read letters or numbers at a set distance. A drop in vision may signal stromal crystals scattering light Cleveland Clinic.

2. Slit-Lamp Biomicroscopy
   A bright, focused beam of light and microscope let doctors see thin, branching opacities deep in the cornea. It is the key test for identifying ICK’s crystal pattern EyeWiki.

3. Fluorescein Staining
   A special yellow dye highlights any surface defects or ulcers. In ICK, surface staining may be minimal, helping distinguish it from other keratitis Cleveland Clinic.

4. Intraocular Pressure Measurement (Tonometry)
   Checking eye pressure ensures no secondary glaucoma. Pressure often remains normal in ICK but must be monitored if long-term steroids are used Cleveland Clinic.

5. Corneal Sensitivity Test
   A soft wisp of cotton or specialized esthesiometer gauges nerve function. Reduced sensitivity may indicate neurotrophic keratopathy, which coexists with ICK Cleveland Clinic.

Manual Tests

6. Corneal Scraping and Smear
   Gently scraping the crystal area collects tissue for immediate microscopic examination. Smears may show gram-positive cocci or fungal elements WebEye.

7. Gram Staining
   Applying crystal violet and iodine to the smear reveals bacterial shape and Gram reaction. Alpha-hemolytic Streptococcus appears as purple, round cocci WebEye.

8. KOH Mount
   A drop of potassium hydroxide clears tissue cells, making fungal filaments stand out under a microscope. This helps detect fungal ICK WebEye.

9. Culture and Sensitivity
   Scrapings are placed on blood, chocolate, or Sabouraud agar to grow bacteria or fungi. Sensitivity tests show which antibiotics or antifungals can kill the germs.

10. Broth Dilution Test
    In liquid culture, varying antibiotic concentrations identify the minimum dose needed to stop germ growth, guiding treatment choice.

Laboratory and Pathological Tests

11. Polymerase Chain Reaction (PCR)
    PCR amplifies tiny amounts of microbial DNA from corneal samples. It can detect bacteria or fungi even when cultures are negative NCBI.

12. Histopathology of Corneal Biopsy
    A small corneal piece is fixed, sliced, and stained to show organisms and biofilm structure in tissue layers NCBI.

13. Enzyme-Linked Immunosorbent Assay (ELISA)
    This blood test detects antibodies or microbial antigens, offering indirect evidence of infection, especially in atypical cases.

14. C-Reactive Protein (CRP) Measurement
    High CRP levels in blood reflect inflammation. Although ICK is often low-grade, a mildly elevated CRP can support an infectious cause.

15. Erythrocyte Sedimentation Rate (ESR)
    A raised ESR indicates some systemic inflammation, which may occur if the keratitis spreads beyond the cornea.

Electrodiagnostic Tests

16. Electroretinography (ERG)
    ERG measures the electrical response of the retina to light. Although focused on deeper eye layers, a normal ERG helps rule out retinal disease when vision loss is attributed to corneal opacity.

17. Electro-oculography (EOG)
    EOG tracks eye movements and corneal potentials. It is rarely used specifically for ICK but can assess overall ocular surface health and nerve function.

Imaging Tests

18. In Vivo Confocal Microscopy
    This high-resolution imaging shows live cells and organisms within the cornea layers. It can visualize biofilms and crystalline deposits without a biopsy NCBI.

19. Anterior Segment Optical Coherence Tomography (AS-OCT)
    AS-OCT uses light waves to create cross-sectional images of the cornea. It measures crystal depth and thickness of stromal opacities.

20. Ultrasound Biomicroscopy (UBM)
    High-frequency ultrasound produces fine images of the cornea and anterior chamber. UBM helps assess deeper structures when opacity blocks light-based imaging.

Non‐Pharmacological Treatments

Each of the following supports corneal health, reduces microbial load, or physically disrupts biofilms without relying on drugs.

1. Cessation/Tapering of Topical Steroids
   Description: Gradually reducing or stopping steroid drops.
   Purpose: Restores local immune response to help clear infection.
   Mechanism: By removing immunosuppression, resident immune cells can better target biofilm-encased bacteria EyeWiki.

2. Diagnostic Keratectomy
   Description: Surgical removal of a small stromal tissue sample.
   Purpose: Confirms causative organism and debulks infected tissue.
   Mechanism: Provides high-yield cultures and physically removes biofilm-laden stroma EyeWiki.

3. Suture Removal
   Description: Extracting corneal sutures, especially those overlying deposits.
   Purpose: Eliminates nidus for microbial colonization.
   Mechanism: Removes epithelial breaches and biofilm harboring structures.

4. Superficial Lamellar Debridement
   Description: Mechanical scraping of the superficial stroma.
   Purpose: Debulks superficial crystalline infiltrates.
   Mechanism: Disrupts biofilm matrix and exposes bacteria to host defenses.

5. Bandage Contact Lens
   Description: Soft, protective lens placed over the cornea.
   Purpose: Promotes epithelial healing and patient comfort.
   Mechanism: Shields raw stroma, maintains moisture, and reduces microtrauma.

6. Punctal Occlusion
   Description: Inserting plugs into tear ducts.
   Purpose: Increases tear film retention and ocular surface lubrication.
   Mechanism: Slows tear drainage, enhancing natural antimicrobial peptides.

7. Preservative-Free Artificial Tears
   Description: Frequent instillation of lubricating eye drops.
   Purpose: Keeps the surface moist and dilutes microbial toxins.
   Mechanism: Reduces friction and flushes surface debris.

8. Warm Compresses & Eyelid Hygiene
   Description: Applying heat to lids followed by cleaning.
   Purpose: Manages coexisting blepharitis or Meibomian gland dysfunction.
   Mechanism: Melts gland secretions, reduces bacterial load on lid margins.

9. Amniotic Membrane Transplantation
   Description: Grafting cryopreserved amniotic tissue onto the cornea.
   Purpose: Encourages healing of persistent epithelial defects.
   Mechanism: Provides growth factors and anti-inflammatory proteins.

10. Scleral or Hybrid Gas-Permeable Lenses
    Description: Specialized lenses that vault over the cornea.
    Purpose: Protects cornea and maintains a fluid reservoir.
    Mechanism: Creates a stable tear film environment and shields against mechanical irritation.

11. Corneal Collagen Cross-Linking (CXL)
    Description: Riboflavin/UVA treatment applied to cornea.
    Purpose: Strengthens stromal collagen and has antimicrobial effects.
    Mechanism: Generates reactive oxygen species that damage microbial DNA and disrupt biofilms.

12. Intrastromal Biofilm Disruption (Nd:YAG Laser)
    Description: Focused laser pulses directed at crystalline plaques.
    Purpose: Physically breaks up biofilm aggregates.
    Mechanism: Creates microcavitation, increasing antibiotic penetration CRSToday.

13. Hyperosmotic Saline Drops
    Description: Drops containing higher salt concentration.
    Purpose: Draws fluid out of edematous stroma.
    Mechanism: Osmotic gradient reduces corneal swelling, improving antibiotic access.

14. Ambient Humidification
    Description: Use of room humidifiers.
    Purpose: Prevents tear film evaporation in dry environments.
    Mechanism: Maintains ambient moisture, protecting epithelial health.

15. Low-Level Light Therapy (Photobiomodulation)
    Description: Near-infrared light applied externally.
    Purpose: Promotes cellular repair and reduces inflammation.
    Mechanism: Stimulates mitochondrial function in corneal epithelial cells.

16. Scleral Tenting
    Description: Temporary manual elevation of the sclera during procedures.
    Purpose: Improves surgical access for lamellar keratectomy.
    Mechanism: Stabilizes globe and exposes deeper stromal layers.

17. Cold Compresses
    Description: Application of chilled packs.
    Purpose: Reduces discomfort and mild inflammation.
    Mechanism: Vaso-constriction decreases local edema.

18. Moisture Goggles
    Description: Sealed goggles that trap humidity.
    Purpose: Ideal for overnight ocular protection.
    Mechanism: Maintains a humid microenvironment, aiding epithelial healing.

19. Epithelial Regeneration Stimulation (Nutritional Support)
    Description: Ensuring adequate protein and vitamin intake.
    Purpose: Supports corneal epithelial cell turnover.
    Mechanism: Minerals and amino acids are building blocks for repair.

20. Contact Lens Discontinuation
    Description: Ceasing all lens wear until resolution.
    Purpose: Eliminates potential source of contamination.
    Mechanism: Prevents recurrent epithelial microtrauma and microbial adhesion.

---

 Evidence-Based Drug Treatments

Below are key antimicrobial agents used against ICK, with typical dosing and considerations.

1. Topical Fortified Vancomycin (50 mg/mL)

   • Class: Glycopeptide antibiotic

   • Dosage & Timing: Instill 1 drop hourly around the clock.

   • Purpose: First-line Gram-positive coverage.

   • Mechanism: Inhibits cell wall peptidoglycan cross-linking.

   • Side Effects: Corneal epithelial toxicity, burning CRSToday.

2. Topical Fortified Ceftazidime (50 mg/mL)

   • Class: Third-generation cephalosporin

   • Dosage & Timing: 1 drop hourly.

   • Purpose: Broad Gram-negative coverage.

   • Mechanism: Binds penicillin-binding proteins, inhibiting cell wall synthesis.

   • Side Effects: Ocular irritation.

3. Topical Moxifloxacin 0.5%

   • Class: Fourth-generation fluoroquinolone

   • Dosage & Timing: 1 drop every 2 hours.

   • Purpose: Convenient monotherapy with broad spectrum.

   • Mechanism: Inhibits bacterial DNA gyrase and topoisomerase IV.

   • Side Effects: Mild stinging.

4. Topical Linezolid 0.2%

   • Class: Oxazolidinone

   • Dosage & Timing: 1 drop every 4 hours.

   • Purpose: Alternative for vancomycin-resistant strains.

   • Mechanism: Prevents formation of the 70S initiation complex.

   • Side Effects: Transient visual disturbances, irritation EyeWiki.

5. Intrastromal Vancomycin Injection (1 mg/0.1 mL)

   • Class: Glycopeptide antibiotic

   • Dosage & Timing: Single or sequential injections under anesthesia.

   • Purpose: Direct high-concentration delivery to infected stroma.

   • Mechanism: Overcomes biofilm barrier for potent Gram-positive kill PMC.

6. Intrastromal Moxifloxacin Injection (0.5 mg/0.1 mL)

   • Class: Fluoroquinolone

   • Dosage & Timing: Single injection targeted to plaques.

   • Purpose: Combats Gram-negative and atypical organisms.

   • Mechanism: Disrupts DNA replication within stroma.

7. Topical Amphotericin B 0.15%

   • Class: Polyene antifungal

   • Dosage & Timing: 1 drop every 2 hours (if fungal ICK).

   • Purpose: Treats fungal crystalline keratopathy.

   • Mechanism: Binds ergosterol, creating cell membrane pores.

   • Side Effects: Epithelial toxicity, discomfort.

8. Topical Voriconazole 1%

   • Class: Triazole antifungal

   • Dosage & Timing: 1 drop every 4 hours.

   • Purpose: Broad-spectrum antifungal alternative.

   • Mechanism: Inhibits ergosterol synthesis.

   • Side Effects: Corneal haze, vision blur.

9. Oral Moxifloxacin 400 mg

   • Class: Fluoroquinolone

   • Dosage & Timing: Once daily.

   • Purpose: Adjunct in severe or refractory cases.

   • Mechanism: Systemic delivery reaches cornea via tears.

   • Side Effects: GI upset, tendon inflammation.

10. Oral Doxycycline 100 mg

    • Class: Tetracycline antibiotic

    • Dosage & Timing: Twice daily.

    • Purpose: Anti-collagenase effect and mild antimicrobial action.

    • Mechanism: Inhibits matrix metalloproteinases, reducing stromal degradation.

    • Side Effects: Photosensitivity, GI upset.

---

Dietary Molecular & Herbal Supplements

Supplementation can support corneal healing and modulate inflammation.

1. Vitamin A (Retinol) – 5,000 IU/day

   • Function: Supports epithelial cell differentiation.

   • Mechanism: Regulates gene expression for mucin production.

2. Vitamin C (Ascorbic Acid) – 500 mg twice daily

   • Function: Collagen synthesis and antioxidant.

   • Mechanism: Cofactor for prolyl hydroxylase in collagen formation.

3. Vitamin E (Tocopherol) – 200 IU/day

   • Function: Lipid-soluble antioxidant protecting cell membranes.

   • Mechanism: Scavenges free radicals in corneal stroma.

4. Omega-3 Fatty Acids (EPA/DHA) – 1,000 mg/day

   • Function: Anti-inflammatory mediator production.

   • Mechanism: Competes with arachidonic acid, reducing pro-inflammatory eicosanoids.

5. N-Acetylcysteine (NAC) – 600 mg twice daily

   • Function: Mucolytic and antioxidant.

   • Mechanism: Precursor to glutathione, neutralizing oxidative stress.

6. Curcumin (Turmeric Extract) – 500 mg twice daily

   • Function: Anti-inflammatory and antimicrobial adjuvant.

   • Mechanism: Inhibits NF-κB pathway, reducing cytokine release.

7. Bilberry Extract – 160 mg twice daily

   • Function: Anthocyanins promote microcirculation.

   • Mechanism: Strengthens capillary walls, enhancing nutrient delivery.

8. Lutein/Zeaxanthin – 10 mg/2 mg daily

   • Function: Antioxidant pigments in ocular tissues.

   • Mechanism: Filters high-energy blue light, reducing phototoxic stress.

9. Resveratrol – 150 mg/day

   • Function: Anti-biofilm and antioxidant.

   • Mechanism: Disrupts bacterial quorum sensing and scavenges radicals.

10. Quercetin – 500 mg/day

    • Function: Flavonoid with anti-inflammatory properties.

    • Mechanism: Inhibits lipoxygenase and cyclooxygenase enzymes.

11. Zinc – 15 mg/day

    • Function: Cofactor for tissue repair enzymes.

    • Mechanism: Supports DNA repair and metalloproteinase regulation.

12. Selenium – 55 mcg/day

    • Function: Component of glutathione peroxidase.

    • Mechanism: Protects against oxidative damage.

13. Coenzyme Q10 – 100 mg/day

    • Function: Mitochondrial energy support.

    • Mechanism: Facilitates ATP production, enhancing cell repair.

14. Green Tea Extract – 300 mg/day

    • Function: Epigallocatechin gallate (EGCG) antioxidant.

    • Mechanism: Inhibits bacterial adhesion and biofilm formation.

15. Probiotic Lactobacillus spp. – 10⁹ CFU/day

    • Function: Balances ocular surface microbiome.

    • Mechanism: Competes with pathogens and modulates immunity.

---

Regenerative & Stem Cell-Related Agents

These biologic therapies boost corneal repair and immunity.

1. Autologous Serum Eye Drops (20%) – 6 times/day

   • Function: Growth factor–rich tear substitute.

   • Mechanism: Supplies EGF, TGF-β, and fibronectin to stimulate epithelial healing.

2. Platelet-Rich Plasma (PRP) Drops – 4 times/day

   • Function: High concentration of platelets and growth factors.

   • Mechanism: Releases PDGF, VEGF, and IGF to promote stromal repair.

3. Umbilical Cord Serum Drops – 20%

   • Function: Alternative for difficult corneal defects.

   • Mechanism: Contains higher levels of neurotrophic factors than autologous serum.

4. Heparin-Binding EGF-Like Growth Factor (HB-EGF) Eye Drops – Experimental

   • Function: Potent stimulator of epithelial proliferation.

   • Mechanism: Binds EGFR, accelerating cell migration and division.

5. ReGeneraTing Agent (RGTA®/Cacicol20) – Twice weekly

   • Function: Matrix-mimetic polymer for tissue scaffolding.

   • Mechanism: Replaces degraded heparan sulfate, stabilizing growth factors in stroma.

6. Limbal Stem Cell Transplantation

   • Function: Restores stem cell population in limbus.

   • Mechanism: Reconstitutes corneal epithelial barrier and prevents recurrent defects.

---

 Surgical Procedures

These are reserved for refractory or advanced disease.

1. Therapeutic Superficial Keratectomy

   • Procedure: Removal of infected anterior stromal lamella.

   • Why: Debulks infection and improves antimicrobial penetration Wiley Online Library.

2. Lamellar (Partial-Thickness) Keratoplasty

   • Procedure: Replaces diseased stromal layers with donor tissue.

   • Why: Clears residual biofilm and preserves host endothelium.

3. Penetrating Keratoplasty

   • Procedure: Full-thickness corneal transplantation.

   • Why: Definitive removal of entire infected cornea when deeper involvement exists EyeWiki.

4. Conjunctival Flap

   • Procedure: Covers cornea with conjunctiva.

   • Why: Provides vascularized tissue to combat infection and support healing.

5. Keratoprosthesis (“Artificial Cornea”)

   • Procedure: Implantation of synthetic corneal device.

   • Why: Last resort for eyes with multiple graft failures or recurrent ICK Review of Optometry.

---

Prevention Strategies

1. Strict Aseptic Technique in Surgery

2. Minimize Prolonged Steroid Use

3. Prompt Treatment of All Ocular Surface Infections

4. Remove Loose or Broken Corneal Sutures Early

5. Avoid Topical Anesthetic Abuse

6. Maintain Contact Lens Hygiene & Discontinue Wear if Irritated

7. Regular Eyelid Hygiene & Blepharitis Management

8. Control Systemic Immunosuppression

9. Ensure Adequate Ocular Surface Lubrication

10. Patient Education on Warning Signs

---

When to See a Doctor

Seek prompt evaluation if you experience:

• Gradual vision blurring or cloudy vision

• New whitish or crystalline spots on cornea

• Persistent mild eye discomfort or foreign-body sensation

• Increased light sensitivity (photophobia)

• Any new redness, even mild

• Worsening of known graft clarity

• Prolonged nonhealing epithelial defects

• Any discharge or stickiness around the eye

---

Nutrition: What to Eat & What to Avoid

Eat:

• Leafy greens (spinach, kale) for lutein/zeaxanthin

• Fatty fish (salmon, mackerel) for omega-3s

• Citrus fruits (oranges, strawberries) for vitamin C

• Nuts & seeds (almonds, sunflower seeds) for vitamin E & zinc

• Colorful berries (blueberries, bilberries) for anthocyanins

Avoid:

• High refined sugar foods (sweets, sodas) that fuel inflammation

• Trans fats (fried fast foods) that impair healing

• Excessive alcohol, which dehydrates ocular surface

• Smoking or tobacco products, which worsen microcirculation

• Unpasteurized dairy or street-vended foods that risk infection

---

FAQs

1. What causes ICK?
   It’s caused by bacteria or fungi colonizing the corneal stroma, often in a biofilm, typically after corneal surgery or steroid use.

2. How is ICK diagnosed?
   Slit-lamp exam shows branching crystalline stromal opacities; confirmed via corneal scrapings, biopsy, or intrastromal culture.

3. Is ICK painful?
   Usually only mildly uncomfortable; it lacks the severe pain seen in other corneal ulcers.

4. Can ICK resolve without surgery?
   Some cases respond to intensive antibiotics and biofilm-disrupting therapies, but many need keratoplasty.

5. How long does treatment take?
   Weeks to months, depending on depth of infection and response to therapy.

6. Is ICK contagious?
   No; it’s a localized infection, not spread by casual contact.

7. Can steroids worsen ICK?
   Yes; steroids suppress immune response and facilitate biofilm formation, so they are tapered when ICK is suspected.

8. Will ICK recur after keratoplasty?
   There is risk of recurrence if biofilm remains or steroid use continues; close follow-up is essential.

9. Are there new treatments for ICK?
   Emerging options include intrastromal antibiotic injections, corneal cross-linking, and laser biofilm disruption.

10. Can contact lenses cause ICK?
    Improperly cleaned or overworn lenses can introduce pathogens and microtrauma, increasing risk.

11. What is the prognosis?
    Variable; early detection and aggressive management improve outcomes, but deep scars may remain.

12. Does ICK affect only grafts?
    While common in grafts, it can occur in native corneas with risk factors like steroid use or epithelial defects.

13. How often should I follow up?
    Initially daily or every few days, then taper based on response; surgical patients require lifelong monitoring.

14. Can ICK lead to blindness?
    If untreated or refractory, deep stromal destruction and scarring can significantly impair vision.

15. Is there a role for systemic antibiotics?
    Systemic therapy (e.g., oral moxifloxacin) may be used in refractory or deep infections but is adjunctive.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 07, 2025.

PDF Document For This Disease Conditions References