Cornea
Diffuse Lamellar Keratitis
Also known as: diffuse lamellar keratitis, DLK, sands of Sahara, LASIK interface inflammation, interface keratitis, interface inflammation, post-LASIK sterile inflammation, post LASIK interface haze
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Diffuse lamellar keratitis (DLK) is sterile interface inflammation after LASIK or flap-based refractive surgery. It is time-sensitive because interface inflammation can threaten vision, but it must be differentiated from infectious keratitis. Optometry should recognise interface haze/infiltrates, document severity and red flags, and arrange urgent refractive surgeon/ophthalmology review. Steroid escalation, flap lift, and interface irrigation are specialist pathway actions.
Recognition
Symptoms: what patients report
- Early postoperative blur, haze, photophobia, or discomfort after LASIK/flap-based surgery.
- Pain can be mild or variable in sterile DLK.
- Reduced vision or increasing symptoms can occur as interface inflammation progresses.
- Severe pain, discharge, late onset, or worsening after initial improvement raises concern for infection.
Signs: what the examination shows
- Diffuse granular white interface haze/infiltrates under the LASIK flap.
- Interface inflammation may be peripheral early and progress centrally.
- Reduced visual acuity if central interface is involved.
- Overlying epithelium may be intact in sterile DLK.
- Focal infiltrate, epithelial defect, discharge, AC reaction, hypopyon, or late onset raises concern for infectious keratitis, which takes priority.
What OptoGuide™ covers for diffuse lamellar keratitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Diffuse Lamellar Keratitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- LASIK Interface Complications: Etiology, Management, and Outcomes. Randleman JB, Shah RD. Journal of Refractive Surgery. 2012;28(8):575-86.
- Refractive Surgery Preferred Practice Pattern. Jacobs DS, Lee JK, Shen TT, et al. Ophthalmology. 2023;130(3):P61-P135.
- Traumatic LASIK Flap Dislocation With Epithelial Ingrowth, Propionibacterium Acnes Infection, and Diffuse Lamellar Keratitis: A Case Report. Chang YC, Lee YC. Medicine. 2020;99(10):e19257.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.