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Causes and management of bacterial keratitis in the elderly
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114.
Abstract:
The author evaluated 142 patients aged 65 years or older with microbial keratitis. There were relatively high rates of Pseudomonas aeruginosa infection unassociated with contact lens wear and of Streptococcus pneumoniae infection. The rates of quasicommensal and enteric infections were not proportionately elevated. Corneal disease, use of topical corticosteroids and use of contact lenses were the main predisposing factors. Patients with diabetes mellitus, dementia or chronic alcoholism appeared to be at higher risk. Trauma was rarely a factor. Complications requiring surgery were common. Corneal perforation developed in 20% of the patients, and endophthalmitis developed in 6%. The elderly often do not tolerate intensive topical antibiotic treatment well. Supplementary subconjunctival antibiotic injections under local anesthesia may be necessary. Corneal tissue glue, tarsorrhaphy and conjunctival flaps are probably underused in this age group.
Insights
Elderly patients with microbial keratitis face high risks of Pseudomonas aeruginosa and Streptococcus pneumoniae infections. Complications like corneal perforation are common, necessitating tailored treatment strategies for this age group.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Microbial keratitis is a significant cause of vision loss, particularly in the elderly.
- Predisposing factors and common pathogens in elderly patients with microbial keratitis require further elucidation.
Purpose of the Study:
- To evaluate the clinical characteristics, predisposing factors, and outcomes of microbial keratitis in patients aged 65 and older.
- To identify specific challenges and potential underutilized treatments in managing microbial keratitis in the elderly population.
Main Methods:
- Retrospective evaluation of 142 patients aged 65+ diagnosed with microbial keratitis.
- Analysis of causative organisms, predisposing factors, treatment modalities, and surgical complications.
Main Results:
- High rates of Pseudomonas aeruginosa and Streptococcus pneumoniae infections were observed.
- Corneal disease, topical corticosteroid use, and contact lens wear were primary predisposing factors.
- Complications including corneal perforation (20%) and endophthalmitis (6%) were frequent; diabetes, dementia, and alcoholism increased risk.
Conclusions:
- Elderly patients with microbial keratitis present unique challenges due to common pathogens and higher complication rates.
- Standard intensive topical antibiotic therapy may be poorly tolerated, suggesting a need for supplementary treatments like subconjunctival injections.
- Surgical interventions such as corneal tissue glue, tarsorrhaphy, and conjunctival flaps may be underutilized and beneficial in this demographic.