Case Report: LabTRIACTIV Achieves Sustained Control of Recurrent Filamentary Keratitis
Case Report
In May 2023, a 67 year-old, Caucasian female presents with complaints of pain, irritation and foreign body sensation only in her left eye. Her right eye was normal upon examination and she had no complaints. She had an unremarkable history of dry eye or other ocular and systemic diseases. Patient had used Systane eye drops (OTC) without any relief.
Filamentary Keratitis (FK)
Filamentary keratitis (FK) is a chronic and recurrent condition, often a complication of ocular and systemic diseases, particularly dry eye disease, as well as ocular interventions. It is characterized by the presence of filaments on the corneal surface, composed primarily of epithelial cells, mucus, and cellular debris, and is associated with symptoms such as foreign body sensation, irritation, tearing, photophobia, and ocular pain.
FK is thought to arise from a dysfunction at the level of the corneal epithelium or Bowman’s membrane, leading to epithelial cells shedding and elongating into strand-like filaments adherent to the cornea, a process exacerbated by eyelid shearing forces. Although its pathogenesis remains incompletely understood, cell desiccation, inflammatory mediators, excessive mucus secretion and mechanical eyelid trauma are considered some of the aggravating factors.
FK therapeutic management targets the underlying ocular surface condition and typically includes filament removal, non-preserved eye lubricants, punctal occlusion, hypertonic eye drops, anti-inflammatory and mucolytic agents, biologic eye drops, and bandage contact lenses. A stepwise and often prolonged therapeutic approach is required to achieve symptom control and reduce recurrence.
While the overall prognosis is fair, FK remains a refractory and debilitating condition that can significantly impair daily activities of patients.
|
Date |
Clinical Findings | Treatment/Intervention | Patient Report/Outcome |
|
May 2023 |
OD: Trace capped glands, with cornea, conjunctiva examination normal. OS: Trace capped glands, with conjunctiva trace injection and with no staining; cornea – 1 filament superiorly attached; TBUT 6 sec |
Prescribed Flarex 0.1% ophthalmic suspension, BID OS x 2 weeks, switched from Systane to Biotrue PF eye lubricant BID Recommended: patient to return in 1 week for follow up. |
Pain, irritation and foreign body sensation, OS only |
|
May 2023 |
OS: Base of filament still present – less pronounced vs. the initial presentation. |
Continue with Flarex for the full 2 weeks; Biotrue PF eye lubricant BID Advised patient to return if no improvement/resolution of symptoms. |
Some symptomatic improvement; no pain; foreign body sensation still present. |
|
May 2023- May 2025 |
6 different visits for flare-ups, occurring every ~ 3-4 months. Her condition remained isolated to OS, with a maximum of 2 active filaments attached to her cornea. |
Each visit: removed the filament; treated with topical steroid for 1-2 weeks. She had continued with Biotrue PF eye drops daily. May 2025: No topical steroid. Switched her from Biotrue PF eye drops to PF LabTRIACTIV BID. Recommended: FUP in 3 months, unless her symptoms aggravate. |
Typical symptoms with each flare-up, with some relief in between. |
|
August 2025 |
Returned for her scheduled FUP visit. OU: normal |
PF LabTRIACTIV BID only FUP visits as needed. |
At 3-months: no flare-ups Patient stable & free of symptoms. |
|
Dec 2025 |
No further FUP visits |
PF LabTRIACTIV BID only |
At 7-months, ongoing stability, with no flare-ups. |
Final Thoughts
Filamentary keratitis (FK) often follows a prolonged and frustrating clinical course. In this case, our therapeutic management focused on mechanical filament removal combined with heavy lubrication and topical anti-inflammatory medications. While these interventions often provide symptomatic relief, repeated mechanical debridement can further compromise the corneal epithelium and perpetuate ocular surface instability. Therefore, effective ocular surface lubrication is essential.
After more than two and a half years of recurrent disease, a sustained flare-free period exceeding seven months was achieved for the first time using preservative-free LabTRIACTIV as monotherapy. This outcome highlights the potential role of advanced lubrication in maintaining ocular surface health and stability and, improving patient comfort.
Notably, effective control was achieved with LabTRIACTIV twice-daily dosing, compared with more frequent regimens previously required, suggesting advantages in treatment adherence and potential cost savings.
About the author:
Dr. Jon Akle was born and raised in Edmonton, where he completed his undergraduate studies at the University of Alberta before earning his Doctor of Optometry degree from Nova Southeastern University in Florida in 2016.
While at Nova, he completed clinical rotations at Bascom Palmer Eye Institute in Miami, gaining valuable hands-on experience in areas such as retina, cornea, neuro-ophthalmology, and glaucoma, which helped spark his interest in ocular disease and research.
After returning to the Edmonton area, Dr. Akle worked in a variety of practice settings before founding Emerald Hills Eye Care in 2018. In 2019, he began focusing more on ocular surface disease management as part of his commitment to providing comprehensive care. He currently serves as President-Elect of the Alberta College of
Optometrists and is also involved in lectures and educational seminars, where he enjoys sharing insights on both practice management and ocular surface disease to support fellow optometrists.
References:
1. Weiss M, Molina R, Ofoegbuna C, Johnson DA, Kheirkhah A. A review of filamentary keratitis. Surv Ophthalmol. 2022 Jan-Feb;67(1):52-59. doi: 10.1016/j.survophthal.2021.04.002. Epub 2021 Apr 20. PMID: 33862042.
2. Ortiz-Morales, G., Nordmann-Gomes, M. C., Navarrete-Azuara, M., Loya-Garcia, D., Navas, A., Ramirez-Miranda, A., & Graue-Hernandez, E. O. (2025). Filamentary Keratitis: A Persistent Challenge in Ocular Surface Disease. Seminars in Ophthalmology, 1–9. https://doi.org/10.1080/08820538.2025.2507296
