Recurrent corneal erosions causing bacterial keratitis

Any etiology of epithelial defect can lead to severe bacterial keratitis. Patients with recurrent corneal erosions suffer repeated corneal epithelial defects without significant trauma and therefore are at risk of infectious keratitis more frequently than someone without recurrent erosions. A stromal infiltrate with an overlying area of epithelial defect can be challenging to differentiate between infectious and noninfectious inflammatory conditions. It is important for clinicians to appreciate the clinical findings in these cases and initiate aggressive treatment promptly.

A 32-year-old woman presented with a history of anterior basement membrane dystrophy and recurrent corneal erosions. She had symptoms of redness, pain, foreign body sensation, photophobia, epiphora, and burning in her left eye that started 2 days before the visit to our office. Examination showed a large epithelial defect with dense stromal infiltrate inferiorly on the cornea that appeared white and milky with diffuse cellular infiltrate as well as 3+ cells in the anterior chamber.

Laboratory results were positive for bacterial keratitis (Staphylococcus aureus). Infectious presentation should be considered visually threatening and treated immediately and aggressively. Early intervention is important to help avoid severe complications.