Bacterial Keratitis

Bacterial Keratitis
SYMPTOMS Pain (usually significant) | Discharge | Photophobia | Blurry vision | Contact lens discomfort
SIGNS Injection | Discharge | Ulcer (SEI + epi defect) | Cells/flare | Corneal edema | Descemet folds
WORK-UP Thorough history. Slit lamp examination with NaFl dye
Discontinue CL wear | Medical management depends on severity and location of infection
Non-central, less severe infection: Broad-spectrum 4th generation topical fluoroquinolone - Vigamox or Besivance 1 gtt q1h | Topical Polytrim - 1 gtt q1h | Consider a loading dose 1 gtt q5min | Consider 1-2 g of oral Vitamin C
Central, severe infection: Vancomycin + fortified tobramycin - alternate 1 gtt q15-60min | Consider a loading dose 1 gtt q5min
Cycloplegic agents are often utilized: Atropine 1% 1 gtt qd-bid | Cyclopentolate 1% 1 gtt tid
Steroids should be considered once epithelialization improves
Oral analgesics are used as necessary (acetaminophen, ibuprofen)
ADDITIONAL LAB | TESTS Consider culturing
ETIOLOGY CL-associated bacterial keratitis stems from contact lens wear (extended wear, overnight wear, etc.) | Possible organisms include: Serratia | Staphylococcus | Streptococcus | Pseudomonas
DIFFERENTIAL DX Acanthamoeba infection| Fungal infection | Sterile corneal infiltrate
NOTES Culturing the cornea and contact lens case may be warranted