Bacterial Keratitis Clinical Presentation

  • Author: Fernando H Murillo-Lopez, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 12, 2012
 

History

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
Next

Physical

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
Previous
Next

Causes

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[1]
  • 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
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jack L Wilson, PhD  Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee Health Science Center College of Medicine

Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Hall BJ, Jones L. Contact Lens Cases: The Missing Link in Contact Lens Safety?. Eye Contact Lens. Jan 19 2010;[Medline].

  2. Khan YA, Kashiwabuchi RT, Martins SA, Castro-Combs JM, Kalyani S, Stanley P. Riboflavin and ultraviolet light a therapy as an adjuvant treatment for medically refractive acanthamoeba keratitis report of 3 cases. Ophthalmology. Feb 2011;118(2):324-31. [Medline].

  3. Haas W, Pillar CM, Torres M, Morris TW, Sahm DF. Monitoring Antibiotic Resistance in Ocular Microorganisms: Results From the Antibiotic Resistance Monitoring in Ocular MicRorganisms (ARMOR) 2009 Surveillance Study. Am J Ophthalmol. Oct 2011;152(4):567-574.e3. [Medline].

  4. Lalitha P, Srinivasan M, Manikandan P, Bharathi MJ, Rajaraman R, Ravindran M, et al. Relationship of In Vitro Susceptibility to Moxifloxacin and In Vivo Clinical Outcome in Bacterial Keratitis. Clin Infect Dis. Mar 23 2012;[Medline].

  5. Bower KS, Kowalski RP, Gordon YJ. Fluoroquinolones in the treatment of bacterial keratitis. Am J Ophthalmol. Jun 1996;121(6):712-5. [Medline].

  6. Caballero AR, Marquart ME, O'Callaghan RJ, Thibodeaux BA, Johnston KH, Dajcs JJ. Effectiveness of fluoroquinolones against Mycobacterium abscessus in vivo. Curr Eye Res. Jan 2006;31(1):23-9. [Medline].

  7. Genvert GI, Cohen EJ, Donnenfeld ED. Erythema multiforme after use of topical sulfacetamide. Am J Ophthalmol. Apr 15 1985;99(4):465-8. [Medline].

  8. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review. Ophthalmology. Jul 1999;106(7):1313-8. [Medline].

  9. Hirst LW, Harrison GK, Merz WG. Nocardia asteroides keratitis. Br J Ophthalmol. Jun 1979;63(6):449-54. [Medline].

  10. Hirst LW, Smiddy WE, Stark WJ. Corneal perforations. Changing methods of treatment, 1960--1980. Ophthalmology. Jun 1982;89(6):630-5. [Medline].

  11. Hyndiuk RA, Eiferman RA, Caldwell DR. Comparison of ciprofloxacin ophthalmic solution 0.3% to fortified tobramycin-cefazolin in treating bacterial corneal ulcers. Ciprofloxacin Bacterial Keratitis Study Group. Ophthalmology. Nov 1996;103(11):1854-62; discussion 1862-3. [Medline].

  12. Knapp A, Stern GA, Hood CI. Mycobacterium avium-intracellulare corneal ulcer. Cornea. 1987;6(3):175-80. [Medline].

  13. Leibowitz HM. Clinical evaluation of ciprofloxacin 0.3% ophthalmic solution for treatment of bacterial keratitis. Am J Ophthalmol. Oct 1991;112(4 Suppl):34S-47S. [Medline].

  14. Moore MB, Newton C, Kaufman HE. Chronic keratitis caused by Mycobacterium gordonae. Am J Ophthalmol. Oct 15 1986;102(4):516-21. [Medline].

  15. Newman PE, Goodman RA, Waring GO 3d. A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures. Am J Ophthalmol. Mar 1984;97(3):344-8. [Medline].

  16. Parmar P, Salman A, Kalavathy CM. Comparison of topical gatifloxacin 0.3% and ciprofloxacin 0.3% for the treatment of bacterial keratitis. Am J Ophthalmol. Feb 2006;141(2):282-286. [Medline].

  17. Pate JC, Jones DB, Wilhelmus KR. Prevalence and spectrum of bacterial co-infection during fungal keratitis. Br J Ophthalmol. Mar 2006;90(3):289-92. [Medline].

  18. Poggio EC, Glynn RJ, Schein OD. The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. N Engl J Med. Sep 21 1989;321(12):779-83. [Medline].

  19. Schein OD, Glynn RJ, Poggio EC. The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. A case-control study. Microbial Keratitis Study Group. N Engl J Med. Sep 21 1989;321(12):773-8. [Medline].

  20. Schlech BA, Alfonso E. Overview of the potency of moxifloxacin ophthalmic solution 0.5% (VIGAMOX). Surv Ophthalmol. Nov 2005;50 Suppl 1:S7-15. [Medline].

  21. Stern GA, Buttross M. Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease. Ophthalmology. Jun 1991;98(6):847-53. [Medline].

  22. Stern GA, Schemmer GB, Farber RD. Effect of topical antibiotic solutions on corneal epithelial wound healing. Arch Ophthalmol. Apr 1983;101(4):644-7. [Medline].

  23. Varma R, eds. Cornea/external diseases. Essentials of Eye Care: The Johns Hopkins Wilmer Handbook. Lippincott Williams & Wilkins;1997:152-203.

 
Previous
Next
 
Human eye anatomy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.