Diffuse lamellar keratitis after laser in situ keratomileusis associated with surgical marker pens

Abstract

There was a strong association between the occurrence of DLK after LASIK with the use of the Codman surgical marker pen. One or more constituents of the ink in the Codman pen may have been responsible for this series of cases.

Diffuse lamellar keratitis after laser in situ keratomileusis with femtosecond laser flap creation

“…It has been associated with factors such as bacterial endotoxin, 4 chemicals or debris, 5 surgical gloves, 6 and surgical marking pens. 7,8 Patient factors shown to affect the risk for DLK include meibomian gland secretions and peripheral immune infiltrates, 9,10 atopy, 11 and iatrogenic epithelial defects. 12,13 Ultimately, DLK is likely the result of how a patient’s endogenous factors respond to exogenous exposures.…”

Treatment of grade IV diffuse lamellar keratitis with oral doxycycline and topical 10% sodium citrate

“…DLK has been attributed to bacterial endotoxins, 6,12-14 chemicals or debris produced during autoclaving, debris from the keratome blade, 15,16 talc from surgical gloves, 17 surgical drapes, 18 marking pens, 19,20 meibomian gland secretions, absorbent sponges, 21,22 allergic disease, 23 iatrogenic epithelial defects, [24][25][26] and povidone-iodine solution. 15 However, all authors agree that DLK is an inflammatory process related to the response to exogenous exposures.…”

LASIK interface keratitis: epidemiology, diagnosis and care

“…During epidemics, factors found to be responsible for outbreaks include endotoxin contamination of sterilizers [30][31][32], certain types of surgical gloves [33,34], certain types of surgical marking pens [35,36], exposure of surgical instruments to toxic chemicals [37] and certain detergents used in cleaning surgical instruments [38]. If an outbreak is suspected, a methodical investigation should be performed to discover and correct the inciting factor.…”