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Bacterial Keratitis Clinical Presentation

  • Author: Fernando H Murillo-Lopez, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 28, 2014
 

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
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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
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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
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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

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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 Heart Association, American Association of Clinical Anatomists

Disclosure: Nothing to disclose.

References
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