Diffuse Lamellar Keratitis


  • Bacterial endotoxin usually contaminating the surgical instruments
  • Severe blepharitis (inflammation of the eyelids)
  • Povidine iodine or betadine solution used to clean the eyelids before surgery
  • Talc powder used on surgical gloves
  • Lubricants used in the motorised blades for cutting a corneal flap
  • Cells from conjunctiva and cornea inadvertently can get into the interface triggering an inflammatory response.
  • Secretions from the eyelids known as meibomian secretions

Signs and symptoms

  • Blood shot eyes
  • Blurry vision
  • Mild soreness to pain in the eye
  • On microscopic examination white cells are seen in the interface between the corneal flap and the corneal bed which might look like sands of Sahara

Classification is by the appearance under the slit lamp microscope.

  • Stage 1 – the vision appears to be normal and the inflammatory cells are either randomly seen in patches or in the periphery of the cornea
  • Stage 2 – the vision might be normal or slightly reduced. The inflammatory cells are seen throughout the stromal bed.
  • Stage 3 – the vision is blurry and the inflammatory cells appear as clusters in the centre of the cornea.
  • Stage 4 – the vision is very much reduced due to scarring of the corneal flap. The corneal flap shows folds and mild cloudiness.


The aim is to control and treat the inflammation. Steroid drops are started on an hourly basis in stages 1 and 2 until the inflammation settles down. Intraocular pressures need careful monitoring as steroids can cause high pressures.

Stage 3 will need a flap lift and washout of the inflammatory cells. Steroid drops are then started on an hourly basis and tailored according to the clinical response.

Stage 4 DLK is usually monitored as flap washout might not improve the condition. The vision does tend to improve over months. Consult the online doctor today for a bespoke, evidence based and confidential medical advice.