Overview of Bacterial Keratitis

Symptoms are usually more than signs.

RISK FACTORS:

OCULAR FACTORS

• Trauma.

• Ocular surface disorders.

• Contact lens wear

• Drugs (Corticosteroids)

SYSTEMIC FACTORS

• Diabetes mellitus

• HIV positive patients (immunocompromised states).

SLIT LAMP EXAMINATION:

• An epithelial defect with surrounding stromal infiltration which is usually different for different organisms.

• Suppurative stromal infiltration.

• Associated conjunctivitis is certain organisms (gonococcal, pneumococcal).

• Chemosis.

• Papillae.

DIAGNOSIS:

• Scrape the ulcer from the ulcer edge and base.

Send for:

• Gram’s stain.

• Giemsa stain.

• Acid fast stains.

• Blood and chocolate agar.

• 10% KOH (to rule out a fungal element).

TREATMENT:

MEDICAL:

• Topical antibiotics (either monotherapy or combination therapy - fortified antibiotics) along with cycloplegics and anti-glaucoma drops

WHEN DO WE ADD SYSTEMIC ANTIBIOTICS?

• Severe keratitis with scleral melting.

• Impending perforations and frank perforations.

SURGICAL:

• Tissue adhesives.

• Patch grafts.

• TPK.

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