Bacterial Keratitis Clinical Presentation
- Author: Fernando H Murillo-Lopez, MD; Chief Editor: Hampton Roy, Sr, MD more...
Patients with bacterial keratitis usually complain of rapid onset of pain, photophobia, and decreased vision. It is important to document a complete systemic and ocular history in these patients to identify any potential risk factors that would have made them susceptible to develop this infection, including the following:
- Contact lens wear (Note the type of lens, wearing time, and type of disinfection system.)
- Trauma (including previous corneal surgery)
- Use of contaminated ocular medications
- Decreased immunologic defenses
- Aqueous tear deficiencies
- Recent corneal disease (herpetic keratitis, neurotrophic keratopathy)
- Structural alteration or malposition of the eyelids
External and biomicroscopic examination of these patients reveals some or all of the following features:
- Ulceration of the epithelium; corneal infiltrate with no significant tissue loss; dense, suppurative stromal inflammation with indistinct edges; stromal tissue loss; and surrounding stromal edema
- Increased anterior chamber reaction with or without hypopyon
- Folds in the Descemet membrane
- Upper eyelid edema
- Posterior synechiae
- Surrounding corneal inflammation that is either focal or diffuse
- Conjunctival hyperemia
- Adherent mucopurulent exudate
- Endothelial inflammatory plaque
Any factor or agent that creates a breakdown of the corneal epithelium is a potential cause or risk factor for bacterial keratitis. Furthermore, exposure to some virulent bacteria that may penetrate intact epithelium (eg, Neisseria gonorrhoeae) also may result in bacterial keratitis.
- By far the most common cause of trauma to the corneal epithelium and the main risk factor for bacterial keratitis is the use of contact lenses, particularly extended-wear contact lenses. Of patients with bacterial keratitis, 19-42% are contact lens wearers. Incidence of bacterial keratitis secondary to use of extended-wear contact lenses is about 8,000 cases per year. The annual incidence of bacterial keratitis with daily-wear lenses is 3 cases per 10,000.
- Contaminated ocular medications, contact lens solutions, or contact lens cases
- Decreased immunologic defenses secondary to malnutrition, alcoholism, and diabetes (Moraxella)
- Aqueous tear deficiencies
- Recent corneal disease (including herpetic keratitis and secondary neurotrophic keratopathy)
- Structural alteration or malposition of the eyelids (including entropion with trichiasis and lagophthalmos)
- Chronic dacryocystitis
- Use of topical corticosteroids
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