eMedicine Specialties > Ophthalmology > Cornea

Keratitis, Bacterial: Follow-up

Author: Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Contributor Information and Disclosures

Updated: Apr 18, 2006

Follow-up

Further Inpatient Care

  • The frequency of antibiotic administration should be tapered off gradually according to the clinical improvement using some of the following parameters:
    • Blunting of the perimeter of the stromal infiltrate
    • Decreased density of the stromal infiltrate
    • Decreased stromal edema and endothelial inflammatory plaque
    • Decreased anterior chamber inflammation and reepithelialization of the corneal epithelial defect
  • Improvement of patient's symptoms

Further Outpatient Care

  • Patients need to be monitored closely to make certain the infection is responding to treatment as the medications are tapered.

Inpatient & Outpatient Medications

  • The antibiotic medications are decreased slowly, depending on the culture and sensitivity results and the clinical response. If topical steroids are used, the antibiotic should not be discontinued.

Deterrence/Prevention

  • Topical antibiotics are given routinely after traumatic injury to the cornea (including surgery).
  • Preventing contamination of topical medications and the use of sterile contact lens solutions are critical steps in preventing contact lens-related infections.

Complications

  • The most feared complication of this condition is thinning of the cornea, secondary descemetocele, and eventual perforation of the cornea that may result in endophthalmitis and loss of the eye.

Prognosis

  • The visual prognosis depends on several factors, as outlined below, and may result in a mild-to-severe decrease in best-corrected visual acuity.
    • Virulence of the organism responsible for the keratitis
    • Extent and location of the corneal ulcer
    • Resulting vascularization and/or collagen deposition

Patient Education

  • Patients who are contact lens wearers (in particular extended-wear contact lenses) should be instructed not to force the use of contact lenses when they have hyperemia, irritation, or foreign body sensation, and to use sterile contact lens solutions to avoid contamination.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Corneal Ulcer.

Miscellaneous

Medicolegal Pitfalls

  • Early diagnosis and prompt treatment help to reduce the possibility of permanent visual loss.

Special Concerns

  • If a presumed bacterial keratitis is not improving clinically despite the use of broad-spectrum antibiotics, suspect an indolent organism (eg, Acanthamoeba, Mycobacteria), perform further laboratory studies to identify the organism, and start specific treatment.
  • Be extremely cautious with the use of topical steroids. Close follow-up care of patients started on topical steroids is mandatory.
 


More on Keratitis, Bacterial

Overview: Keratitis, Bacterial
Differential Diagnoses & Workup: Keratitis, Bacterial
Treatment & Medication: Keratitis, Bacterial
Follow-up: Keratitis, Bacterial
References
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References

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

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

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

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

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

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

  7. 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].

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

  9. 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].

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

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. 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].

  17. 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].

  18. 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].

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

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Further Reading

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Keywords

corneal ulcer, ulcerative keratitis

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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.

Medical Editor

Jack L Wilson, PhD, Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis
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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

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.

 
 
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