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Infective Keratitis

Infective Keratitis is the inflammation of the cornea due to infection. The most common cause of it is HSV (Herpes simplex virus). Other causes include:

  • Bacterial – Pseudomonas or Staphylococcus

  • Fungal – Candida or Aspergillus

  • Exposure Keratitis – Inadequate eyelid coverage e.g. ectropion


N.B. Pseudomonas is the most common cause in contact lens wearers.


Presentation

  • Painful red eye

  • Photophobia

  • Dendritic corneal ulcer – branching and spreading of the ulcer

  • Watery (Viral) or Sticky (Bacterial)

  • Reduced visual acuity

  • Hypopyon if bacterial


Investigations

  • Fluorescein staining - Will show dendritic corneal ulcer (stains green in areas that have lost epithelium i.e. ulcers)

  • Slit-lamp examination

  • Corneal swab/scrape for culture

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“Dendritic pattern after fluorescein staining” © Imrankabirhossain CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

  • Viral - Aciclovir or Ganciclovir

  • Bacterial - Ciprofloxacin

  • Corneal transplant may be required after the infection has resolved to treat any scarring



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