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Keratitis

Last reviewed: 9 Nov 2024
Last updated: 22 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • corneal infiltrate
  • corneal ulcer
  • dendritic or geographic epithelial lesion
  • periocular skin lesions
  • multifocal corneal ulcer with feathery edges
  • corneal perineuritis
  • interstitial keratitis
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • corneal scraping: microscope slide
  • corneal scraping: cultures and sensitivity
Full details

Tests to consider

  • CBC
  • HIV test
  • autoimmune testing
  • corneal scraping: polymerase chain reaction (PCR) testing
Full details

Treatment algorithm

INITIAL

bacterial (presumed): high risk

ACUTE

bacterial

herpetic

fungal

protozoan (Acanthamoeba)

noninfectious keratitis

ONGOING

recurrent herpetic infection

corneal scarring impairing vision

Contributors

Authors

Kraig S. Bower, MD

Director of Refractive Surgery

The Wilmer Eye Institute

The Johns Hopkins Hospital

Baltimore

MD

Disclosures

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

Disclosures

FSH declares that he has no competing interests.

Acknowledgements

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.

  • Keratitis images
  • Differentials

    • Corneal abrasion
    • Vernal keratoconjunctivitis with shield ulcer
    • Dry eye or exposure keratitis
    More Differentials
  • Guidelines

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    • Cornea/external disease summary benchmarks - 2023
    More Guidelines
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