Filamentary keratitis occurring after strabismus surgery

We report the case of a 58-year-old woman who developed filamentary keratitis after undergoing uncomplicated strabismus surgery for exotropia secondary to third-nerve palsy with a large head turn and incomitant left exotropia. Her symptoms were controlled after a bandage contact was used. No similar cases of filamentary keratitis occurring after strabismus surgery have been reported. Filamentary keratitis is usually associated with symptoms of ocular irritation and foreign-body sensation. Filamentary keratitis occurs in association with numerous disorders: keratoconjunctivitis sicca, superior limbic keratoconjunctivitis, epidemic keratoconjunctivitis, postcataract extraction,(1) post-penetrating keratoplasty,(2) neurotrophic keratitis,(3) herpetic keratitis, bullous keratopathy, eyelid occlusion,(4) brain stem injury,(5) diphenhydramine hydrochloride use,(6) hereditary hemorrhagic telangiectasis,(7) retrobulbar injection of botulinum toxin,(8) and anticardiolipin antibodies.(9) The exact pathogenesis of this entity remains unclear.(10) Filament formation results from a derangement in the corneal epithelium and a relative excess of mucus. The excess mucus is usually secondary to chronic irritation, and the location of the filaments depends on the type of underlying corneal pathology.