Bacterial Keratitis

Clinical Description

Corneal inflammation caused by bacterial infection

Risk factors: Contact lens wear, trauma, ocular surface disease (such as herpetic keratitis, bullous keratopathy, and dry eyes), chronic blepharitis, trichiasis, and exposure keratopathy, severe allergic eye disease and corneal anesthesia). Other factors include topical or systemic immunosuppression such as diabetes, vitamin A deficiency and measles.

Signs and Symptoms

• Painful red eyes, Photophobia, blurred vision, Mucopurulent or purulent discharge, Circumlimbal injection and corneal opacities ± oedema ± anterior uveitis,
• May complicate with limbal and scleral extensions, corneal perforations and endophthalmitis.

Investigations

• Corneal scrapings (microscopy, culture, sensitivity)

Treatment

• Topical antibiotics
• Initially at hourly intervals day and night for up to 48 hours. Later reduced to 2-hourly during waking hours for a further 48 hours then every 6hrs for 7 days or until the epithelium has healed.
• Consider using eye ointments eg Chloramphenicol eye ointment 1% or Tetracycline eye ointment 1%
• Oral antibiotics
• Give Ciprofloxacin 750mg every 12hrs 7-10 days or Augmentin 625mg every 12hrs 7-10 days (in threatened or actual corneal perforation or a peripheral ulcer in which there is scleral extension, for isolates for which there are potential systemic complications e.g., N. Meningitides).
• Subconjunctival antibiotics
• Only indicated if there is poor compliance with topical treatment.
• Cycloplegics (Atropine 1% gut every 12hrs or Cyclopentolate 1% gut every 8hrs).
• Topical steroids therapy to reduce corneal scarring ONLY after the ulcer has been sterilized and fungal infection has been excluded.
• RED FLAGS:
• Consider using a bandage contact lens in impending or actual corneal perforation
• Counsel patient and guardians on visual prognosis