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
Other diagnostic factors
- redness
- pain
- increased lacrimation
- lid edema
- discharge
- decreased visual acuity
- photophobia
- high intraocular pressure
- history of herpes simpex virus 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
- history of autoimmune disease
Diagnostic investigations
1st investigations to order
- corneal scraping: microscope slide
- corneal scraping: cultures and sensitivity
Investigations to consider
- CBC
- HIV test
Emerging tests
- corneal scraping: polymerase chain reaction
Treatment algorithm
bacterial (presumed): high risk
bacterial
herpetic
fungal
protozoan (Acanthamoeba)
noninfectious keratitis
recurrent herpetic infection
corneal scarring impairing vision
Contributors
Authors
Kraig Scot 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 Scot 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.
Differentials
- Peripheral ulcerative keratitis
- Mooren ulcer
- Corneal abrasion
More DifferentialsGuidelines
- Bacterial keratitis preferred practice pattern
- Fungal keratitis - Asia Pacific
More GuidelinesPatient leaflets
Herpes simplex eye infection
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer