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
		TREATMENT
			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)
		FOLLOW-UP	Daily
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