Last reviewed: October 2018
Last updated: March  2018



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

Other diagnostic factors

  • redness
  • pain
  • increased lacrimation
  • lid edema
  • discharge
  • decreased visual acuity
  • photophobia
  • high intraocular pressure
  • Hx of HSV or Varicella zoster virus infection
  • multiple old stromal scars
  • iris transillumination
  • corneal hypoesthesia

Risk factors

  • contact lens wear
  • corneal trauma
  • corneal abrasion/erosion
  • trichiasis
  • blepharitis
  • dry eye
  • poor eyelid function
  • previous herpetic disease
  • exposure keratitis
  • recurrent corneal erosions
  • contaminated water exposure
  • topical corticosteroid use
  • topical anesthetic use
  • previous eye surgery
  • immunocompromised
  • hx of autoimmune disease

Diagnostic investigations

1st investigations to order

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

Emerging tests

  • corneal scraping: PCR
Full details

Treatment algorithm


Authors VIEW ALL

Director of Refractive Surgery

The Wilmer Eye Institute

The Johns Hopkins Hospital




KSB declares that he has no competing interests.

Assistant Professor

Cornea, External Disease and Refractive Surgery

Kresge Eye Institute

Wayne State University




FSH declares that he has no competing interests.

Dr Kraig Scot Bower and Dr Frank S. Hwang would like to gratefully acknowledge Dr Julie Freidlin Leigh, a previous contributor to this monograph. JFL declares that she has no competing interests.

Peer reviewers VIEW ALL

Proctor Fellow in Cornea and External Disease

Francis I. Proctor Foundation

University of California

San Francisco



MC declares that she has no competing interests.

Senior Lecturer & Consultant

Ophthalmic Surgeon

Division of Infection, Inflammation & Immunity

University of Southampton

Southampton General Hospital




PH declares that he has no competing interests.

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