Sterile Corneal Infiltrate: A Difficult Dilemma

Area of Science:

• Ophthalmology
• Corneal Diseases
• Infectious Diseases

Background:

• Corneal infiltrates are common in ophthalmic emergencies, presenting as either sterile or infectious.
• Sterile corneal infiltrate (SCI) is less understood than infectious keratitis, often occurring post-contact lens wear or corneal procedures (CXL, PRK, LASIK).
• Accurate differentiation between SCI and infectious keratitis is critical due to differing treatment strategies.

Purpose of the Study:

• To highlight the importance of distinguishing between sterile corneal infiltrate (SCI) and infectious keratitis.
• To discuss the clinical features that may help differentiate SCI from infectious keratitis.
• To outline the recommended management strategies for SCI.

Main Methods:

• Review of clinical presentations and differentiating features of sterile versus infectious corneal infiltrates.
• Discussion of diagnostic challenges faced by ophthalmologists.
• Analysis of treatment approaches, emphasizing corticosteroids for SCI and the role of antibiotics.

Main Results:

• Infectious keratitis typically presents with mucopurulent discharge, significant pain, photophobia, epithelial defects, larger infiltrates, and anterior chamber reaction.
• Sterile corneal infiltrates (SCI) are often associated with an intact epithelial layer and may be smaller.
• Distinguishing between SCI and infectious infiltrates can be challenging, even for specialists.

Conclusions:

• Corneal scraping is advisable for diagnosis unless SCI is highly suggestive.
• The primary treatment for SCI involves topical corticosteroids, with concurrent topical antibiotics recommended.
• Close monitoring is essential, especially in immunocompromised patients on corticosteroids, due to potential fungal infections.