Summary
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- corneal infiltrate
- corneal ulcer
- dendritic or geographic epithelial lesion
- periocular skin lesions
- multifocal corneal ulcer with feathery edges
- corneal perineuritis
- interstitial keratitis
Другие диагностические факторы
- redness
- pain
- increased lacrimation
- lid edema
- discharge
- decreased visual acuity
- photophobia
- high intraocular pressure
- history of herpes simplex virus or varicella zoster virus infection
- multiple old stromal scars
- iris transillumination
- corneal hypoesthesia
Факторы риска
- contact lens wear
- corneal trauma
- corneal abrasion/erosion
- recurrent corneal erosions
- immunocompromise
- history of autoimmune disease
- trichiasis
- blepharitis
- dry eye
- poor eyelid function
- previous herpetic disease
- exposure keratitis
- contaminated water exposure
- topical corticosteroid use
- topical anesthetic use
- previous eye surgery
Диагностические исследования
Исследования, которые показаны в первую очередь
- corneal scraping: microscope slide
- corneal scraping: cultures and sensitivity
Исследования, проведение которых нужно рассмотреть
- CBC
- HIV test
- autoimmune testing
- corneal scraping: polymerase chain reaction (PCR) testing
Алгоритм лечения
bacterial (presumed): high risk
bacterial
herpetic
fungal
protozoan (Acanthamoeba)
noninfectious keratitis
recurrent herpetic infection
corneal scarring impairing vision
Составители
Авторы
Kraig S. Bower, MD
Director of Refractive Surgery
The Wilmer Eye Institute
The Johns Hopkins Hospital
Baltimore
MD
Раскрытие информации
KSB declares that he has no competing interests.
Frank S. Hwang, MD
Assistant Professor
Cornea, External Disease and Refractive Surgery
Loma Linda University Eye Institute
Loma Linda University
Loma Linda
CA
Раскрытие информации
FSH declares that he has no competing interests.
Выражение благодарностей
Dr Kraig S. Bower and Dr Frank S. Hwang would like to gratefully acknowledge Dr Julie Freidlin Leigh, a previous contributor to this topic.
Disclosures
JFL declares that she has no competing interests.
Peer reviewers
Matilda Chan, MD, PhD
Proctor Fellow in Cornea and External Disease
Francis I. Proctor Foundation
University of California
San Francisco
CA
Disclosures
MC declares that she has no competing interests.
Parwez Hossain, MD, PhD, FRCOphth, FRCS (Ed)
Senior Lecturer & Consultant
Ophthalmic Surgeon
Division of Infection, Inflammation & Immunity
University of Southampton
Southampton General Hospital
Southampton
UK
Disclosures
PH declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Rhee MK, Ahmad S, Amescua G, et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P87-133.Full text Abstract
Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;(10):CD005430.Full text Abstract
Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;(1):CD002898.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Corneal abrasion
- Vernal keratoconjunctivitis with shield ulcer
- Dry eye or exposure keratitis
More DifferentialsGuidelines
- Bacterial keratitis preferred practice pattern
- Cornea/external disease summary benchmarks - 2024
More GuidelinesPatient information
Herpes simplex eye infection
More Patient information
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