Microbial keratitis resulting in loss of the eye

The purpose of this study was to determine the clinical characteristics of infected corneal ulcers resulting in loss of the eye.

The authors conducted a retrospective study of all cases requiring evisceration or enucleation due to microbial keratitis at Wills Eye Hospital between January 1, 1989, and December 31, 1995. Medical records were reviewed to determine the past medical and ophthalmic history, duration of symptoms and treatment prior to referral, and the size of the ulcer at time of presentation. Treatment, culture results, and clinical course were also analyzed.

During the study period, 1.8% (17 of 965) of the patients with corneal ulcers admitted to Wills Eye Hospital underwent evisceration or enucleation for microbial keratitis. The median age of the patients was 67 years (+/- 20.1 years). A majority of the patients (82%, 14 of 17) had a history of preexisting ocular disease resulting in poor visual acuity. The median duration of symptoms prior to presentation to Wills Eye Hospital was 11.4 days (+/- 13.9 days). The average size of the corneal infiltrate was 40.8 mm2 (+/- 38.7 mm2). The most common pathogens were Pseudomonas (7 cases) and Streptococcus (3 cases). Patients required evisceration (14 cases) or enucleation (3 cases) due to uncontrolled infection.

Microbial keratitis resulting in loss of the eye occurred typically in patients who were elderly with preexisting poor visual acuity, who presented with severe infections due to virulent organisms or delayed treatment.