- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 24, 2024
Laser eye surgery has revolutionised vision correction, offering millions of people the opportunity to reduce or eliminate their dependence on glasses and contact lenses. However, like any surgical procedure, it comes with potential risks and complications. One such complication is diffuse lamellar keratitis (DLK), also known as “Sands of Sahara” syndrome. At Blue Fin Vision® Eye Clinic on Harley Street in London, we believe in empowering our patients with comprehensive knowledge about their eye health. This article delves into the intricacies of DLK, its causes, symptoms, and treatment options.
Understanding Diffuse Lamellar Keratitis
Diffuse lamellar keratitis is a non-infectious inflammatory condition that can occur after laser eye surgery, particularly following LASIK (Laser-Assisted In Situ Keratomileusis) procedures. It typically develops within the first week after surgery and is characterised by an accumulation of inflammatory cells between the corneal flap and the underlying stromal bed.
The Corneal Structure
To better understand DLK, it’s crucial to have a basic grasp of the cornea’s structure:
- Epithelium: The outermost layer of the cornea
- Bowman’s Layer: A thin layer beneath the epithelium
- Stroma: The thickest layer, comprising about 90% of the cornea’s thickness
- Descemet’s Membrane: A thin layer beneath the stroma
- Endothelium: The innermost layer of the cornea
During LASIK surgery, a thin flap is created in the cornea, typically including the epithelium, Bowman’s layer, and part of the stroma. DLK occurs in the interface between this flap and the remaining stromal bed.
Causes of Diffuse Lamellar Keratitis
The exact cause of DLK is not always clear, but several factors have been identified as potential triggers:
Surgical Factors
- Debris under the flap: Microscopic particles or debris trapped under the corneal flap during surgery
- Instrument-related issues: Residues from surgical instruments or sterilisation processes
- Laser energy: Excessive laser energy during the procedure
Patient-related Factors
- Pre-existing conditions: Certain inflammatory conditions or allergies may predispose patients to DLK
- Meibomian gland dysfunction: This can increase the risk of developing DLK
- Atopy: Patients with atopic conditions may be more susceptible
Environmental Factors
- Air quality: Poor air quality in the operating room or recovery area
- Solutions used: Certain solutions used during or after surgery may trigger an inflammatory response
Post-operative Factors
- Eye rubbing: Excessive rubbing of the eyes post-surgery can irritate the corneal interface
- Trauma: Any trauma to the eye in the immediate post-operative period
Symptoms of Diffuse Lamellar Keratitis
The symptoms of DLK can vary in severity and may include:
- Blurred or hazy vision: This is often the first noticeable symptom
- Light sensitivity: Increased sensitivity to bright lights
- Eye discomfort: Mild to moderate discomfort or a feeling of grittiness in the eye
- Redness: The eye may appear slightly red or inflamed
- Tearing: Excessive tearing may occur as the eye attempts to flush out irritants
It’s important to note that DLK is typically painless, which distinguishes it from infectious complications. However, any unusual symptoms following laser eye surgery should be promptly reported to your eye care professional.
Stages of Diffuse Lamellar Keratitis
DLK is typically classified into four stages based on its severity:
Stage 1
- Characterised by white granular cells in the periphery of the corneal flap interface
- Usually asymptomatic and may resolve on its own
Stage 2
- The granular infiltrate spreads towards the centre of the cornea
- Mild symptoms may begin to appear
Stage 3
- Denser aggregates of inflammatory cells form, often in the central cornea
- More noticeable visual symptoms
Stage 4
- Severe inflammation leading to stromal melting and permanent scarring
- Significant visual impairment
Early detection and treatment are crucial to prevent progression to later stages and potential long-term visual complications.
Diagnosis of Diffuse Lamellar Keratitis
At Blue Fin Vision® Eye Clinic in London, our expert ophthalmologists use various methods to diagnose DLK:
Slit-lamp Examination
This is the primary diagnostic tool. The characteristic appearance of white, granular cells in the corneal interface can be observed using a slit-lamp microscope.
Confocal Microscopy
This advanced imaging technique can provide detailed views of the corneal layers, helping to confirm the diagnosis and assess the severity of DLK.
Optical Coherence Tomography (OCT)
OCT can provide cross-sectional images of the cornea, helping to visualise the inflammatory infiltrates and assess their extent.
Patient History
A thorough review of the patient’s surgical history, post-operative care, and symptom onset is crucial for accurate diagnosis.
Treatment of Diffuse Lamellar Keratitis
The treatment approach for DLK depends on its severity and stage. Our Harley Street clinic offers a range of treatment options:
Stage 1 and 2 DLK
- Topical corticosteroids: Increased frequency of steroid eye drops to reduce inflammation
- Close monitoring: Regular follow-up appointments to assess response to treatment
Stage 3 DLK
- Aggressive topical corticosteroids: More potent steroid drops or increased frequency
- Oral corticosteroids: In some cases, systemic steroids may be prescribed
- Flap lift and irrigation: If necessary, the corneal flap may be lifted and the interface irrigated to remove inflammatory cells
Stage 4 DLK
- Urgent intervention: Immediate and aggressive treatment is crucial
- Flap lift and irrigation: Often necessary to prevent permanent corneal damage
- Intensive steroid therapy: Both topical and systemic
- Potential additional surgeries: In severe cases, further surgical interventions may be required
Prevention of Diffuse Lamellar Keratitis
While it’s not always possible to prevent DLK, several measures can reduce the risk:
- Stringent surgical protocols: Ensuring a sterile operating environment and proper instrument maintenance
- Proper post-operative care: Following all post-surgical instructions carefully
- Avoiding eye rubbing: Patients should refrain from rubbing their eyes in the immediate post-operative period
- Regular follow-ups: Attending all scheduled post-operative appointments for early detection of any complications
Long-term Outlook
With prompt diagnosis and appropriate treatment, the prognosis for DLK is generally excellent. Most cases resolve without long-term visual impairment. However, severe or untreated cases can lead to permanent corneal scarring and vision loss, underscoring the importance of early intervention.
Why Choose Blue Fin Vision® Eye Clinic for Your Laser Eye Surgery?
At Blue Fin Vision® Eye Clinic, located on prestigious Harley Street in London, we offer:
- Expert Care: Our team of highly skilled ophthalmologists has extensive experience in performing laser eye surgery and managing potential complications like DLK.
- State-of-the-Art Technology: We utilise the latest diagnostic and treatment technologies to ensure the best possible outcomes for our patients.
- Comprehensive Aftercare: Our commitment to your eye health extends well beyond the day of surgery, with thorough follow-up care and support.
- Patient Education: We believe in empowering our patients with knowledge, ensuring you’re fully informed at every step of your journey to better vision.
Conclusion
Diffuse lamellar keratitis, while a potential complication of laser eye surgery, is typically manageable with prompt diagnosis and appropriate treatment. At Blue Fin Vision® Eye Clinic in London, we’re committed to providing exceptional care throughout your laser eye surgery experience, from initial consultation to long-term follow-up.
If you’re considering laser eye surgery or have concerns about post-operative complications, we invite you to schedule a consultation with our expert team. Let us help you achieve clearer vision while ensuring the health and safety of your eyes.
Remember, your vision is precious, and at Blue Fin Vision® Eye Clinic, we’re dedicated to helping you see the world more clearly. Don’t let concerns about potential complications hold you back from exploring the benefits of laser eye surgery. Contact us today to take the first step towards improved vision.
