Filamentary Keratitis: A Persistent Challenge in Ocular Surface Disease.

Purpose: To provide a comprehensive overview of filamentary keratitis (FK), its pathophysiology, associated conditions, clinical manifestations, and current management strategies.

Methods: A narrative review of the literature describing the etiopathogenesis, clinical features, and therapeutic approaches for FK. Emphasis was placed on conventional treatments, advanced medical therapies, and surgical interventions used in refractory cases.

Results: FK is a chronic ocular surface disorder marked by the presence of mucus-epithelial filaments adhered to the cornea, frequently associated with dry eye disease, autoimmune disorders, and neurotrophic or exposure keratopathies. Its pathogenesis involves tear film instability, excessive mucus production, and mechanical trauma from blinking. Management remains challenging due to high recurrence rates. Standard treatments include lubrication, mechanical debridement, topical corticosteroids, and mucolytics such as N-acetylcysteine. In severe or refractory cases, autologous serum tears, punctal occlusion, bandage contact lenses, and surgical procedures like amniotic membrane transplantation or tarsorrhaphy are effective in stabilizing the ocular surface and reducing symptoms.

Conclusion: FK is a multifactorial and recurrent disease that requires a tailored therapeutic approach. Early recognition and multimodal management are essential for symptom control and prevention of further ocular surface damage. Emerging therapies and surgical options expand the armamentarium for treating refractory cases, improving patient outcomes.