Keratopathy may be described as inflammation of the cornea.

Keratopathy may be due to many different causes. These include: viral conjunctivitis; Acanthamoeba infection; overexposure to ultraviolet light; trachoma; overwearing of contact lenses; some systemic drugs; toxicity to topical eye drugs or their preservatives; herpes simplex; inadequate tear volume; Lyme disease (see diagnostic code: 6319 lyme disease); Epstein-Barr virus; vitamin A deficiency (see diagnostic code: 6313 avitaminosis); trauma; collagen vascular disease; and rare instances of tuberculosis (see diagnostic code: 6730 tuberculosis); and syphilis (see diagnostic code: 6310 syphilis).

The signs and symptoms of the condition are dependent on the underlying cause. Generally, pain and photophobia are always present. Excess tearing, decreased vision, a feeling of a foreign body in the eye, redness of the conjunctiva, corneal ulcers, and pus may appear in the anterior chamber.

Staining the eye with fluorescein dye can outline lesions that are not otherwise visible. Use of a slit lamp is very helpful in examinations to identify corneal lesions. The patient history is most important in revealing possible foreign bodies in the cornea or previous treatment of corneal trauma. In addition, use of medications for systemic diseases such as diabetes mellitus (see diagnostic code: 7913 diabetes mellitus); AIDS (see diagnostic code: 6351 HIV-related illnesses); and malignant disease may affect the cornea. Previous use of local corticosteroids in the eye may predispose to bacterial, fungal, or viral eye disease.

Treatment varies according to the underlying cause and the extent of the condition. Treatment measures may include: artificial tears; local antibiotic ointment and eye drops; corticosteroid ointment; systemic medications for herpes; eyedrops to keep the pupil dilated (mydriatics); eye patching; and treatment of a vitamin deficiency (see diagnostic code: 6313 avitaminosis). Corneal transplantation may be performed when vision is lost from a diseased cornea.

Complications following corneal transplant include: possible rejection, infection, bleeding, glaucoma, and recurrence of the disease. The prognosis for a functioning transplant varies from 50 to 90% of cases depending upon the underlying diagnosis. Chemical, radiation burns, or previous corneal transplants have the lowest success rate.

• Consider service connection on a presumptive basis as a condition associated with mustard gas exposure (38 CFR 3.316).

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eye.

• Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.