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ALL / Ophthalmology

Keratitis

Keratitis

Keratitis describes inflammation of the cornea. Microbial keratitis is not like conjunctivitis - it is potentially sight threatening and should therefore be urgently evaluated and treated.


Aetiology

Causes
  • bacterial
    • typically Staphylococcus aureus
    • Pseudomonas aeruginosa is seen in contact lens wearers
  • fungal
  • amoebic
    • acanthamoebic keratitis
    • accounts for around 5% of cases
    • increased incidence if eye exposure to soil or contaminated water
    • pain is classically out of proportion to the findings
  • parasitic: onchocercal keratitis ('river blindness')

Remember, other factors may causes keratitis:
  • viral: herpes simplex keratitis
  • environmental
    • photokeratitis: e.g. welder's arc eye
    • exposure keratitis
    • contact lens acute red eye (CLARE)


Clinical features

Features
  • red eye: pain and erythema
  • photophobia
  • foreign body, gritty sensation
  • hypopyon may be seen


Evaluation and management

Referral
  • contact lens wearers
    • assessing contact lens wearers who present with a painful red eye is difficult
    • an accurate diagnosis can only usually be made with a slit-lamp, meaning same-day referral to an eye specialist is usually required to rule out microbial keratitis

Management
  • stop using contact lens until the symptoms have fully resolved
  • topical antibiotics
    • typically quinolones are used first-line
  • cycloplegic for pain relief
    • e.g. cyclopentolate

Complications may include:
  • corneal scarring
  • perforation
  • endophthalmitis
  • visual loss
+PassMedicine Notes

Keratitis describes inflammation of the cornea. Microbial keratitis is not like conjunctivitis - it is potentially sight threatening and should therefore be urgently evaluated and treated.

Aetiology

Causes
  • bacterial
    • typically Staphylococcus aureus
    • Pseudomonas aeruginosa is seen in contact lens wearers
  • fungal
  • amoebic
    • acanthamoebic keratitis
    • accounts for around 5% of cases
    • increased incidence if eye exposure to soil or contaminated water
    • pain is classically out of proportion to the findings
  • parasitic: onchocercal keratitis ('river blindness')
Remember, other factors may causes keratitis:
  • viral: herpes simplex keratitis
  • environmental
    • photokeratitis: e.g. welder's arc eye
    • exposure keratitis
    • contact lens acute red eye (CLARE)

Clinical features

Features
  • red eye: pain and erythema
  • photophobia
  • foreign body, gritty sensation
  • hypopyon may be seen

Evaluation and management

Referral
  • contact lens wearers
    • assessing contact lens wearers who present with a painful red eye is difficult
    • an accurate diagnosis can only usually be made with a slit-lamp, meaning same-day referral to an eye specialist is usually required to rule out microbial keratitis
Management
  • stop using contact lens until the symptoms have fully resolved
  • topical antibiotics
    • typically quinolones are used first-line
  • cycloplegic for pain relief
    • e.g. cyclopentolate
Complications may include:
  • corneal scarring
  • perforation
  • endophthalmitis
  • visual loss


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