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Perineural infiltrates in Pseudomonas keratitis

Scott J Robbie1, Felipe A Vega, Naing L Tint

  • 1From Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.

Journal of Cataract and Refractive Surgery
|October 29, 2013
PubMed

Insights

Perineural infiltrates in contact lens-related keratitis can be caused by Pseudomonas aeruginosa, not just Acanthamoeba. Prompt treatment with levofloxacin led to rapid recovery in these cases.

Area of Science:

  • Ophthalmology
  • Microbiology
  • Infectious Diseases

Background:

  • Contact lens wear is a significant risk factor for microbial keratitis.
  • Perineural infiltrates on presentation can suggest specific etiologies, historically Acanthamoeba.
  • Pseudomonas aeruginosa is a common and potentially severe cause of bacterial keratitis.

Observation:

  • Two cases of contact lens-related microbial keratitis presented with perineural infiltrates.
  • Confocal microscopy was negative for Acanthamoeba cysts in both patients.
  • Corneal scrapings confirmed Pseudomonas aeruginosa infection via microscopy and bacterial culture.

Findings:

  • Perineural infiltrates are not exclusive to Acanthamoeba infections and can be present in Pseudomonas aeruginosa keratitis.
  • Early and accurate diagnosis of bacterial keratitis is crucial for appropriate management.

Implications:

  • Clinicians should consider Pseudomonas aeruginosa as a potential cause of keratitis with perineural infiltrates.
  • This finding broadens the differential diagnosis for perineural infiltrates in microbial keratitis.
  • Prompt initiation of targeted antibiotic therapy, such as topical levofloxacin, can lead to favorable outcomes.

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