Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- corneal infiltrate
- corneal ulcer
- dendritic or geographic epithelial lesion
- periocular skin lesions
- multifocal corneal ulcer with feathery edges
- corneal perineuritis
- interstitial keratitis
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- corneal scraping: microscope slide
- corneal scraping: cultures and sensitivity
Pruebas diagnósticas que deben considerarse
- CBC
- HIV test
- autoimmune testing
- corneal scraping: polymerase chain reaction (PCR) testing
Algoritmo de tratamiento
bacterial (presumed): high risk
bacterial
herpetic
fungal
protozoan (Acanthamoeba)
noninfectious keratitis
recurrent herpetic infection
corneal scarring impairing vision
Colaboradores
Autores
Kraig S. Bower, MD
Director of Refractive Surgery
The Wilmer Eye Institute
The Johns Hopkins Hospital
Baltimore
MD
Divulgaciones
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
Divulgaciones
FSH declares that he has no competing interests.
Agradecimientos
Dr Kraig S. Bower and Dr Frank S. Hwang would like to gratefully acknowledge Dr Julie Freidlin Leigh, a previous contributor to this topic.
Divulgaciones
JFL declares that she has no competing interests.
Revisores por pares
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
Declarações
PH declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
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Referências
Principais artigos
Rhee MK, Ahmad S, Amescua G, et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P87-133.Texto completo Resumo
Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;(10):CD005430.Texto completo Resumo
Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;(1):CD002898.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Corneal abrasion
- Vernal keratoconjunctivitis with shield ulcer
- Dry eye or exposure keratitis
Mais Diagnósticos diferenciaisDiretrizes
- Bacterial keratitis preferred practice pattern
- Cornea/external disease summary benchmarks - 2024
Mais DiretrizesFolhetos informativos para os pacientes
Herpes simplex eye infection
Mais Folhetos informativos para os pacientes
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