SERIOUS OCCURRENCES IN THE NATURAL-HISTORY OF ADVANCED CLIMATIC KERATOPATHY

Background: Climatic or chronic actinic keratopathy is an important co rneal degeneration occurring after prolonged climatic exposure. The ad vanced stages of disease are confined generally to tropical or arid lo calities (including the Arctic) with high levels of sunlight. After ma ny years of disease evolution, the advent of stage 3 keratopathy often presages a rapid downhill course. The instability of advanced climati c keratopathy has received little attention. Methods: Eighteen patient s with advanced climatic keratopathy are described from the Transvaal region in South Africa and from Saudi Arabia. Patients with rapid dise ase progression, spontaneous sterile ulceration, and secondary microbi al keratitis are described. Results: The rapid progression characteris tic of stage 3 climatic keratopathy is illustrated. Severe, focal, ste rile ulceration of the devitalized corneal degeneration may be common. Secondary infection may occur, leading to rapid dissolution of the cl imatic keratopathy material. Corneal perforation may ensue. The occurr ence of yellow or brown fragments of the climatic keratopathy within o r adjacent to the corneal inflammatory infiltrate indicates the predis posing cause of the infection, as usually also with examination of the opposite eye.Conclusions: These observations emphasize the inherent i nstability of advanced climatic keratopathy, which frequently takes a relentless downhill course. In rural populations of the developing wor ld, climatic keratopathy is an important cause of blindness. Disease p athogenesis, treatment, and prevention deserve greater study.