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Infectious keratitis: A review
Maria Cabrera-Aguas1,2, Pauline Khoo1,2, Stephanie L Watson1,2
1Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Abstract:
Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.
Insights
Infectious keratitis, a major cause of blindness, is often linked to contact lens wear or eye injury. Prompt diagnosis and appropriate antimicrobial therapy are crucial to prevent vision loss and eye damage.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Infectious keratitis is a significant global cause of blindness.
- Key risk factors include contact lens wear, ocular trauma, and ocular surface disease.
- Common causative agents include bacteria (Staphylococcus, Pseudomonas aeruginosa), fungi (Fusarium, Candida), and Acanthamoeba.
Purpose of the Study:
- To review the diagnosis and management of infectious keratitis.
- To highlight common pathogens and effective treatment strategies.
- To emphasize the importance of timely intervention to prevent severe visual outcomes.
Main Methods:
- Corneal scraping culture as the primary diagnostic tool.
- Polymerase chain reaction (PCR) and in vivo confocal microscopy as complementary diagnostic methods.
- Clinical diagnosis for herpes simplex keratitis, with PCR for confirmation.
Main Results:
- Empiric treatment involves fluoroquinolones or fortified antibiotics for bacterial keratitis.
- Topical natamycin is used for fungal keratitis.
- Polyhexamethylene biguanide or chlorhexidine are treatments for Acanthamoeba keratitis.
- Antivirals and corticosteroids are used for herpes simplex keratitis based on corneal involvement.
Conclusions:
- Prompt and accurate diagnosis is essential for effective management of infectious keratitis.
- Appropriate antimicrobial therapy is critical to prevent vision impairment, blindness, and potential eye loss.
- Understanding predisposing factors and common organisms aids in timely and successful treatment.
