Bacterial keratitis: Difference between revisions
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*Rapidly progressing, with corneal destruction as fast as within 24 hrs | *Rapidly progressing, with corneal destruction as fast as within 24 hrs | ||
*Corneal perforation is most sight threatening complication | *Corneal perforation is most sight threatening complication | ||
*Strep, staph, pseudomonas, enterobacteriaceae | *[[Strep]], [[staph]], [[pseudomonas]], [[enterobacteriaceae]] | ||
*Risk factors | *Risk factors | ||
**Contact lens use | **[[Contact lens]] use | ||
**Corneal surgery, trauma | **Corneal surgery, [[ocular trauma|trauma]] | ||
**Chronic dry eye | **Chronic dry eye | ||
**Recent corneal disease (viral, fungal keratitis) | **Recent corneal disease (viral, fungal keratitis) | ||
**Immune deficiency, topical steroids | **Immune deficiency, [[topical steroids]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Blurred vision | *[[Blurred vision]] | ||
*Severe pain and photophobia | *Severe [[eye pain|pain]] and photophobia | ||
*Perilimbic injection | *Perilimbic injection | ||
*Normal pupil size | *Normal pupil size | ||
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*[[UV keratitis]] | *[[UV keratitis]] | ||
*[[Herpes zoster]] | *[[Herpes zoster]] | ||
*Contact lens complication | *[[contact lens problems|Contact lens complication]] | ||
*Fungal keratitis | *Fungal keratitis | ||
*[[Bacterial keratitis]] | *[[Bacterial keratitis]] | ||
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==Evaluation== | ==Evaluation== | ||
*Topical anesthesia with proparacaine, as opposed to tetracaine which has bacteriostatic effects, limiting culture results | *Topical anesthesia with proparacaine, as opposed to [[tetracaine]] which has bacteriostatic effects, limiting culture results | ||
*Culture and gram stain of corneal ulcer edges, eyelids, conjunctiva, contact lenses | *Culture and gram stain of corneal ulcer edges, eyelids, conjunctiva, contact lenses | ||
*Ultrasound to assess for signs of endophthalmitis and other pathologies | *[[ocular ultrasound|Ultrasound]] to assess for signs of endophthalmitis and other pathologies | ||
==Management== | ==Management== | ||
*Broad spectrum topical antibiotics; 1 drop q1 hr | *Broad spectrum topical [[antibiotics]]; 1 drop q1 hr | ||
**Tobramycin 14mg/ml | **[[Tobramycin]] 14mg/ml | ||
**Alternate with fortified cefazolin 50mg/ml | **Alternate with fortified [[cefazolin]] 50mg/ml | ||
*Smaller corneal ulcers may be treated with moxifloxacin or gatifloxacin ophthalmic | *Smaller corneal ulcers may be treated with [[moxifloxacin]] or [[gatifloxacin]] ophthalmic | ||
==Disposition== | ==Disposition== | ||
Revision as of 15:57, 5 October 2019
Background
- Rapidly progressing, with corneal destruction as fast as within 24 hrs
- Corneal perforation is most sight threatening complication
- Strep, staph, pseudomonas, enterobacteriaceae
- Risk factors
- Contact lens use
- Corneal surgery, trauma
- Chronic dry eye
- Recent corneal disease (viral, fungal keratitis)
- Immune deficiency, topical steroids
Clinical Features
- Blurred vision
- Severe pain and photophobia
- Perilimbic injection
- Normal pupil size
- Eyelid edema
- Mucopurulent exudate
- Posterior synechiae (iris adheres to cornea)
Differential Diagnosis
- Iritis
- Conjunctivitis
- Glaucoma
- UV keratitis
- Herpes zoster
- Contact lens complication
- Fungal keratitis
- Bacterial keratitis
- Interstitial keratitis
- Herpes keratitis
- Endophthalmitis
Evaluation
- Topical anesthesia with proparacaine, as opposed to tetracaine which has bacteriostatic effects, limiting culture results
- Culture and gram stain of corneal ulcer edges, eyelids, conjunctiva, contact lenses
- Ultrasound to assess for signs of endophthalmitis and other pathologies
Management
- Broad spectrum topical antibiotics; 1 drop q1 hr
- Tobramycin 14mg/ml
- Alternate with fortified cefazolin 50mg/ml
- Smaller corneal ulcers may be treated with moxifloxacin or gatifloxacin ophthalmic
Disposition
- Ophtho consult for possible perforation risk
- Eye patch in the interim
References
- Murillo-Lopez F et al. Bacterial Keratitis. Aug 24, 2014. http://emedicine.medscape.com/article/1194028-overview.