Interstitial Keratitis

Interstitial keratitis is when the middle layer of the cornea (called the stroma) becomes inflamed without any open sore on the surface or back of the cornea. This inflammation causes new blood vessels to grow into the clear cornea, making it cloudy and harming vision. In simple terms, imagine the clear window on the front of your eye getting tiny red lines inside it and turning foggy, which makes it hard to see EyeWikiMedlinePlus.

Interstitial keratitis (IK) is inflammation of the corneal stroma—the thick, transparent middle layer of the eye’s front window—without any open sores on the surface (epithelium) or the inner layer (endothelium). In simple terms, imagine the cornea as a clear, multilayered pane of glass. In IK, the middle “pane” becomes inflamed and flooded with tiny blood vessels, turning normally clear tissue into a pinkish haze. This can blur vision and, if untreated, lead to scarring and permanent vision loss EyeWikiMedlinePlus.

The corneal stroma normally has neatly arranged fibers that let light pass through in a straight line. When inflammation hits, immune cells rush in and blood vessels invade, leaving scars and haze behind. This cloudiness and scarring can be mild at first but may become permanent if not treated early EyeWiki.

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Types of Interstitial Keratitis

There are two broad categories based on what triggers the inflammation:

• Infectious Interstitial Keratitis
  Caused by germs such as bacteria, viruses, or parasites directly invading the cornea. Common infectious types include syphilitic keratitis, herpetic keratitis (from herpes viruses), and tuberculosis-related keratitis EyeWiki.

• Immune-Mediated (Noninfectious) Interstitial Keratitis
  Results from the body’s immune system reacting to other diseases without an active infection in the cornea. Examples are Cogan syndrome, sarcoidosis, and rheumatoid arthritis affecting the cornea EyeWiki.

• Congenital vs. Acquired

  • Congenital forms are present from birth, most often due to untreated syphilis passed from mother to child.

  • Acquired forms develop later in life from new infections or immune conditions.

• Acute vs. Chronic

  • Acute interstitial keratitis comes on suddenly with active inflammation.

  • Chronic or inactive interstitial keratitis shows old blood vessels (ghost vessels) and scarring after the inflammation has calmed but leaves lasting cloudiness EyeWiki.

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Causes of Interstitial Keratitis

1. Congenital Syphilis – Passed from mother to baby before birth, leading to corneal inflammation in childhood MedlinePlus.

2. Acquired Syphilis – A sexually transmitted infection that can later affect the eye MedlinePlus.

3. Herpes Simplex Virus (HSV) – A common virus that can invade corneal tissue and trigger inflammation EyeWiki.

4. Varicella Zoster Virus (VZV) – The chickenpox/shingles virus can affect the cornea, causing interstitial keratitis EyeWiki.

5. Tuberculosis (TB) – Mycobacterium tuberculosis infection can involve the cornea in rare cases MedlinePlus.

6. Lyme Disease – A tick-borne infection by Borrelia burgdorferi that can lead to corneal inflammation MedlinePlus.

7. Leprosy – A bacterial infection (Mycobacterium leprae) that sometimes causes interstitial keratitis MedlinePlus.

8. Epstein-Barr Virus (EBV) – The virus behind mono may rarely infect the cornea EyeWiki.

9. Cogan Syndrome – An autoimmune condition that affects the eyes and inner ears EyeWiki.

10. Rheumatoid Arthritis – An autoimmune joint disease that can also inflame the cornea MedlinePlus.

11. Sarcoidosis – A condition causing lumps of immune cells in organs, including the eye MedlinePlus.

12. Systemic Lupus Erythematosus – An autoimmune disease that can involve the cornea EyeWiki.

13. Sjӧgren’s Syndrome – An autoimmune disorder mainly affecting tear glands but sometimes the cornea EyeWiki.

14. Granulomatosis with Polyangiitis (formerly Wegener’s) – A blood vessel inflammation that can involve the eye EyeWiki.

15. Reactive Arthritis (Reiter’s Syndrome) – Joint inflammation following infection can extend to the cornea EyeWiki.

16. Mumps Virus – Rarely causes corneal inflammation as part of generalized infection EyeWiki.

17. Measles Virus – In very rare cases can involve the cornea EyeWiki.

18. Onchocerciasis – A parasitic worm infection common in some countries, leading to river blindness and corneal disease EyeWiki.

19. Idiopathic – When no definite cause can be found despite testing .

20. Yaws (T. pallidum pertenue) – A tropical spirochetal infection similar to syphilis that can inflame the cornea EyeWiki.

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Symptoms of Interstitial Keratitis

1. Red Eye – The white part of the eye turns pink or red from blood vessel growth Merck Manuals.

2. Eye Pain – A dull or sharp ache in and around the eye MedlinePlus.

3. Light Sensitivity (Photophobia) – Bright lights feel uncomfortable or painful Merck Manuals.

4. Excessive Tearing (Epiphora) – Too many tears flow as a response to irritation MedlinePlus.

5. Blurred Vision – Cloudiness and scarring make it hard to see clearly Merck Manuals.

6. Foreign Body Sensation – Feels like something is in the eye Merck Manuals.

7. Decreased Visual Acuity – Measured loss of sharpness or clarity of vision Merck Manuals.

8. Corneal Haze – A ground-glass appearance of the cornea when examined closely Merck Manuals.

9. Stromal Opacity – The middle corneal layer turns white or gray Merck Manuals.

10. Neovascularization – Tiny new blood vessels visible in the cornea Merck Manuals.

11. Salmon Patches – Orange-red spots where vessels have grown in Merck Manuals.

12. Eye Soreness with Blinking – Discomfort worsens when blinking Merck Manuals.

13. Ciliary Flush – Red ring around the cornea from deeper blood vessels Merck Manuals.

14. Grittiness – Feels like sand or grit under the eyelids Merck Manuals.

15. Photopsias – Seeing flashes of light in severe inflammation Merck Manuals.

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Diagnostic Tests for Interstitial Keratitis

Physical Exam

1. Visual Acuity Test – Measures how clearly you see letters on a chart.

2. Slit-Lamp Biomicroscopy – A special microscope with light beam to look at corneal layers MedlinePlus.

3. Intraocular Pressure (IOP) Measurement – Checks eye pressure to rule out glaucoma.

4. Pupillary Reaction Assessment – Observes how pupils respond to light.

Manual Tests

5. Corneal Sensitivity (Cochet-Bonnet Esthesiometry) – Uses a thin nylon filament to touch the cornea and test nerve function.

6. Schirmer’s Tear Test – Measures tear production by placing filter paper under the eyelid.

7. Tear Break-Up Time (TBUT) – Instills dye and measures time until tear film breaks.

8. Fluorescein Staining – Applies dye to spot any surface damage even though interstitial keratitis is deeper.

Laboratory & Pathological Tests

9. RPR/VDRL – Blood tests for active syphilis MedlinePlus.

10. FTA-ABS/TPHA – More specific blood tests confirming syphilis.

11. HSV/VZV PCR – Detects herpes virus DNA in eye fluid.

12. Lyme Serology (ELISA/Western Blot) – Checks antibodies to Borrelia burgdorferi.

13. TB Skin Test (PPD) or IGRA – Tests for tuberculosis infection.

14. ACE Level – Blood test to support sarcoidosis diagnosis.

15. Rheumatoid Factor (RF) – Blood marker for rheumatoid arthritis.

16. ANA (Antinuclear Antibodies) – Screens for lupus and other autoimmunity.

17. ESR/CRP – General inflammation markers in the blood.

Electrodiagnostic Tests

18. Corneal Esthesiometer Readings – Measures electrical threshold for corneal sensation.

19. Visual Evoked Potentials (VEP) – Assesses the visual pathway to rule out other nerve problems.

Imaging Tests

20. Anterior Segment OCT (Optical Coherence Tomography) – High-resolution scans showing corneal thickness and layers EyeWiki.

21. In Vivo Confocal Microscopy – Provides microscopic images of corneal cells and nerves EyeWiki.

22. Ultrasound Pachymetry – Measures corneal thickness using sound waves EyeWiki.

23. B-Scan Ultrasound – Checks deeper eye structures if the front is too cloudy to see through .

Non-Pharmacological Treatments

Below are 20 supportive therapies and procedures—free of traditional drug use—each described in simple English, with its purpose and how it helps the inflamed cornea:

1. Lubricating Eye Drops (Artificial Tears)

   • Description: Gel-like drops you put in your eye.

   • Purpose: Keep the surface moist to ease discomfort and prevent friction.

   • Mechanism: Mimics natural tears, forming a protective film over the stromal tissue ScienceDirect.

2. Moisture Chamber Goggles

   • Description: Special goggles or wraparound shields that trap moisture.

   • Purpose: Maintain high humidity around the eye.

   • Mechanism: Reduces tear evaporation to soothe inflammation.

3. Warm Compress Therapy

   • Description: A clean cloth soaked in warm water, placed over closed eyelids.

   • Purpose: Improve blood flow and comfort.

   • Mechanism: Gently warms tissues to support natural healing and melt thick secretions.

4. Eyelid Hygiene and Massage

   • Description: Gentle scrubbing and massage of eyelid margins with diluted baby shampoo.

   • Purpose: Remove debris and reduce surface irritation.

   • Mechanism: Clears clogged oil glands, promoting healthier tear film.

5. Blinking and Lid-Wiper Exercises

   • Description: Guided routines of full, deliberate blinks and lid sweeps.

   • Purpose: Redistribute tears evenly.

   • Mechanism: Enhances tear spread, reducing dry spots on the cornea.

6. Punctal Occlusion (Non-Drug Device)

   • Description: Tiny plugs inserted into tear ducts.

   • Purpose: Slow tear drainage.

   • Mechanism: Keeps natural tears on the eye longer to protect the stroma.

7. Bandage Contact Lenses

   • Description: Soft lenses worn continuously.

   • Purpose: Shield the cornea from blinking-related trauma.

   • Mechanism: Forms a barrier that promotes a stable healing environment.

8. Amniotic Membrane Transplant (Bio-Tissue Graft)

   • Description: Layer from placenta tissue placed on the cornea.

   • Purpose: Accelerate healing and reduce inflammation.

   • Mechanism: Releases growth factors and anti-scarring proteins NCBI.

9. Therapeutic Scleral Lenses

   • Description: Large, gas-permeable lenses that vault over the cornea.

   • Purpose: Create a fluid-filled reservoir.

   • Mechanism: Hydrates and protects the stroma continuously.

10. Corneal Cross-Linking (CXL)

    • Description: A light-activated procedure that strengthens corneal fibers.

    • Purpose: Halt the progression of stromal thinning and scarring.

    • Mechanism: UV light plus riboflavin forms new bonds in collagen.

11. Phototherapeutic Keratectomy (PTK)

    • Description: Laser smoothing of the corneal surface.

    • Purpose: Remove superficial scarring and irregularities.

    • Mechanism: Targets and ablates damaged stromal tissue.

12. Therapeutic Ultrasound Waves

    • Description: Low-energy sound waves directed at the eye.

    • Purpose: Stimulate cell repair.

    • Mechanism: Promotes anti-inflammatory signaling in stromal cells.

13. Intense Pulsed Light (IPL) Therapy

    • Description: Light pulses aimed at eyelid glands.

    • Purpose: Treat associated meibomian gland dysfunction.

    • Mechanism: Liquefies gland blockages, supporting a healthy tear film.

14. Nutritional Counseling (Non-Drug Lifestyle)

    • Description: Guidance on diet rich in eye-healthy nutrients.

    • Purpose: Support overall eye healing.

    • Mechanism: Ensures building blocks (vitamins, antioxidants) for tissue repair.

15. Environmental Control (Humidifier Use)

    • Description: Using room humidifiers.

    • Purpose: Prevent drying of the ocular surface.

    • Mechanism: Maintains ambient moisture, reducing evaporation.

16. Blue-Light Filters and Protective Eyewear

    • Description: Glasses that block harsh or UV light.

    • Purpose: Minimize light-induced irritation.

    • Mechanism: Filters out high-energy wavelengths that can worsen inflammation.

17. Rest and Screen-Time Management

    • Description: Scheduled breaks from digital screens.

    • Purpose: Reduce strain and dryness.

    • Mechanism: Encourages blinking and tear distribution.

18. Cold Compress Therapy

    • Description: Cooled, damp cloth on closed eyes.

    • Purpose: Narrow blood vessels to reduce redness.

    • Mechanism: Vasoconstriction eases stromal swelling.

19. Acupuncture

    • Description: Fine-needle insertion around the eye area by a trained practitioner.

    • Purpose: Alleviate discomfort and support nerve-mediated healing.

    • Mechanism: May trigger release of anti-inflammatory neuropeptides.

20. Mind-Body Relaxation Techniques

    • Description: Practices such as guided imagery or meditation.

    • Purpose: Lower overall inflammation by reducing stress.

    • Mechanism: Modulates the body’s stress response, which can influence immune activity.

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Drug Treatments

Below are ten key medicines used in IK, each with class, typical dosing, timing, purpose, how they work, and possible side effects:

1. Loteprednol Etabonate Ophthalmic Gel

   • Class: Corticosteroid

   • Dosage & Time: 0.5% gel, one drop four times daily for 2–4 weeks.

   • Purpose: Reduce stromal inflammation.

   • Mechanism: Blocks inflammatory chemicals (cytokines) in corneal tissue.

   • Side Effects: Mild burning, increased intraocular pressure if used long-term Drugs.com.

2. Dexamethasone/Neomycin/Polymyxin B Ophthalmic Suspension

   • Class: Steroid + Antibiotics

   • Dosage & Time: One drop every 6 hours for 2 weeks.

   • Purpose: Control inflammation and prevent bacterial infection.

   • Mechanism: Steroid component suppresses immune cells; antibiotics kill bacteria.

   • Side Effects: Ocular irritation, potential steroid-induced glaucoma Drugs.com.

3. Tobramycin/Dexamethasone Ophthalmic Suspension

   • Class: Antibiotic + Steroid

   • Dosage & Time: One drop every 6 hours for 10–14 days.

   • Purpose: Same as above, used when pseudomonal risk is higher.

   • Mechanism: Synergistic infection control and inflammation reduction.

   • Side Effects: Irritation, risk of antibiotic resistance.

4. Cyclosporine A Ophthalmic Emulsion (0.05%)

   • Class: Calcineurin Inhibitor

   • Dosage & Time: One drop twice daily for 3–6 months.

   • Purpose: Modulate immune response to reduce chronic inflammation.

   • Mechanism: Inhibits T-cell activation in corneal stroma.

   • Side Effects: Burning sensation on instillation ScienceDirect.

5. Tacrolimus Ophthalmic Ointment (0.03%)

   • Class: Calcineurin Inhibitor

   • Dosage & Time: Apply a thin ribbon twice daily.

   • Purpose: Alternative immune suppression for steroid-resistant cases.

   • Mechanism: Blocks cytokine release by T-cells.

   • Side Effects: Transient itching or irritation PMC.

6. Moxifloxacin Ophthalmic Solution (0.5%)

   • Class: Fluoroquinolone Antibiotic

   • Dosage & Time: One drop every 4 hours for 7–10 days.

   • Purpose: Treat or prevent secondary bacterial infection.

   • Mechanism: Inhibits bacterial DNA gyrase.

   • Side Effects: Mild irritation.

7. Voriconazole Ophthalmic Drops (1%)

   • Class: Antifungal

   • Dosage & Time: One drop every 2 hours for 1 week, then taper.

   • Purpose: Treat fungal-related IK (rare).

   • Mechanism: Disrupts fungal cell membrane synthesis.

   • Side Effects: Stinging, blurry vision.

8. Oral Acyclovir (400 mg)

   • Class: Antiviral

   • Dosage & Time: 400 mg five times daily for 7–10 days.

   • Purpose: Manage herpetic causes of IK.

   • Mechanism: Inhibits viral DNA polymerase.

   • Side Effects: Headache, nausea.

9. Oral Prednisone

   • Class: Systemic Corticosteroid

   • Dosage & Time: 0.5 mg/kg/day for 1–2 weeks, then taper.

   • Purpose: Treat severe or bilateral stromal inflammation.

   • Mechanism: Suppresses widespread immune activity.

   • Side Effects: Weight gain, increased blood sugar.

10. Oral Doxycycline (100 mg)

    • Class: Tetracycline Antibiotic

    • Dosage & Time: 100 mg once daily for 4–6 weeks.

    • Purpose: Anti-inflammatory effects and inhibition of matrix metalloproteinases.

    • Mechanism: Reduces tissue-damaging enzymes in stroma.

    • Side Effects: Photosensitivity, GI upset.

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Dietary Molecular & Herbal Supplements

Support corneal health with these supplements, each in simple terms:

1. Omega-3 Fatty Acids (Fish Oil) — 1000 mg daily

   • Function: Anti-inflammatory.

   • Mechanism: Modulates cytokine release in ocular tissues PMC.

2. Vitamin A (Retinol) — 10,000 IU daily

   • Function: Epithelial maintenance.

   • Mechanism: Supports cell differentiation in corneal surface.

3. Vitamin C (Ascorbic Acid) — 500 mg twice daily

   • Function: Collagen synthesis.

   • Mechanism: Essential cofactor for stromal collagen repair.

4. Vitamin D (Cholecalciferol) — 2000 IU daily

   • Function: Immune modulation.

   • Mechanism: Balances pro- and anti-inflammatory responses.

5. Lutein & Zeaxanthin — 10 mg/2 mg daily

   • Function: Antioxidant protection.

   • Mechanism: Filters harmful blue light.

6. Curcumin — 500 mg twice daily

   • Function: Anti-inflammatory.

   • Mechanism: Inhibits NF-κB signaling in stromal cells.

7. Quercetin — 500 mg daily

   • Function: Antioxidant.

   • Mechanism: Scavenges free radicals.

8. Bilberry Extract — 160 mg daily

   • Function: Vascular health.

   • Mechanism: Strengthens capillary walls, reducing neovascularization.

9. Green Tea Polyphenols — 250 mg daily

   • Function: Anti-angiogenic.

   • Mechanism: Inhibits new vessel growth in stroma ScienceDirect.

10. Zinc (Zinc Gluconate) — 40 mg daily

    • Function: Enzyme cofactor.

    • Mechanism: Supports antioxidant enzymes in eye.

11. Selenium — 100 µg daily

    • Function: Antioxidant.

    • Mechanism: Cofactor for glutathione peroxidase.

12. Vitamin E (α-Tocopherol) — 400 IU daily

    • Function: Membrane protection.

    • Mechanism: Prevents lipid peroxidation in corneal cells.

13. N-Acetylcysteine — 600 mg twice daily

    • Function: Mucolytic and antioxidant.

    • Mechanism: Breaks down debris and replenishes glutathione.

14. Astaxanthin — 4 mg daily

    • Function: Potent antioxidant.

    • Mechanism: Crosses blood-ocular barrier to protect stromal cells.

15. Ginkgo Biloba — 120 mg daily

    • Function: Microcirculation support.

    • Mechanism: Improves blood flow to ocular tissues.

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Regenerative & Stem Cell Drugs

Emerging therapies aiming to rebuild corneal tissue:

1. Cenegermin-bkbj Ophthalmic Solution (0.002%)

   • Dosage: One drop six times daily for 8 weeks.

   • Function: Nerve growth factor.

   • Mechanism: Stimulates corneal nerve regeneration NCBI.

2. Autologous Serum Eye Drops (20%)

   • Dosage: Four to six drops daily for 4–8 weeks.

   • Function: Growth factor supply.

   • Mechanism: Uses patient’s own serum rich in healing proteins.

3. Mesenchymal Stem Cell-Derived Exosomes

   • Dosage: Under clinical trial protocols.

   • Function: Anti-inflammatory and regenerative.

   • Mechanism: Delivers signaling molecules to stromal cells.

4. Limbal Stem Cell Allograft (CALEC)

   • Dosage: Single surgical implantation.

   • Function: Restore limbal epithelial progenitors.

   • Mechanism: Reconstitutes healthy corneal epithelium EyeWiki.

5. Induced Pluripotent Stem Cell (iPSC)-Derived Corneal Cells

   • Dosage: Under investigation.

   • Function: Replace damaged stromal keratocytes.

   • Mechanism: Differentiates into corneal cell types.

6. Collagen-Hydrogel Scaffold with Stem Cells

   • Dosage: Single surgical placement.

   • Function: Structural support plus cell delivery.

   • Mechanism: Scaffold promotes cell integration and repair.

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Surgical Procedures

When conservative measures fail, surgery may be needed:

1. Amniotic Membrane Transplantation

   • Procedure: Graft placental tissue onto cornea.

   • Why: Provides anti-scarring and anti-inflammatory factors NCBI.

2. Tarsorrhaphy

   • Procedure: Partially stitch eyelids together.

   • Why: Reduces corneal exposure and dryness.

3. Phototherapeutic Keratectomy (PTK)

   • Procedure: Excimer laser ablation of scarred stroma.

   • Why: Smoothes irregular tissue to improve vision.

4. Penetrating Keratoplasty (Corneal Transplant)

   • Procedure: Replace full-thickness cornea.

   • Why: For advanced scarring threatening vision.

5. Lamellar Keratoplasty

   • Procedure: Replace only the damaged stromal layers.

   • Why: Preserves healthy inner corneal tissue.

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Prevention Strategies

Simple steps to lower IK risk:

1. Treat systemic infections (e.g., syphilis) promptly.

2. Maintain strict eyelid hygiene to prevent surface contamination.

3. Manage autoimmune conditions under doctor supervision.

4. Wear UV-blocking sunglasses outdoors.

5. Avoid rubbing the eyes.

6. Use protective eyewear in dusty or chemical environments.

7. Keep contact lenses clean and replace as directed.

8. Control blood sugar if diabetic.

9. Maintain humid indoor air, especially in dry climates.

10. Schedule regular eye exams for early detection.

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When to See a Doctor

Seek prompt care if you experience:

• Sudden redness, pain, or light sensitivity.

• Blurred vision not improved by rest.

• New or worsening corneal blood vessels.

• Discharge or eye fever.

• Any change in vision during or after infection.

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What to Eat & What to Avoid

Eat: Green leafy vegetables, oily fish, citrus fruits, nuts, seeds, and whole grains to supply antioxidants, vitamins A, C, and E, and omega-3 fatty acids.
Avoid: Excessive sugar, processed foods, and trans fats, which can fuel inflammation.

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Frequently Asked Questions (FAQs)

1. Can IK recur?
   Yes. Recurrence is common, especially with untreated underlying causes.

2. Is vision loss permanent?
   Early treatment often prevents lasting scars. Advanced cases may need transplantation.

3. Are eye drops enough?
   Mild cases respond to drops; severe or chronic IK may need surgery or systemic therapy.

4. Can contact lenses help?
   Bandage lenses can protect the cornea but must be fitted and monitored by a specialist.

5. Is IK contagious?
   No—it is inflammation, not an infection you catch from others.

6. How long does healing take?
   With treatment, symptoms often improve within weeks, but full recovery can take months.

7. Are natural remedies effective?
   Supplements and lifestyle changes support healing but are not a replacement for medical care.

8. Can steroids worsen infection?
   Yes—steroids without antibiotics can allow hidden infections to flare.

9. Is surgery painful?
   Procedures are done under anesthesia; discomfort afterward is managed with pain relief.

10. Will I need lifelong treatment?
    Some patients require long-term maintenance drops or periodic care.

11. Can I drive during treatment?
    If vision is impaired or you feel pain, arrange alternate transport until vision stabilizes.

12. Does diet really matter?
    A nutrient-rich diet supports healing but cannot cure IK alone.

13. What exercises help eye health?
    Blinking exercises and taking digital-screen breaks reduce dryness.

14. Are there new IK medications?
    Research on growth-factor eye drops and stem cell therapies is ongoing.

15. How often to follow up?
    Initially every 1–2 weeks, then as directed by your ophthalmologist.

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.

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