Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- infiltrado corneano
- úlcera de córnea
- lesão epitelial dendrítica ou geográfica
- lesões cutâneas perioculares
- úlcera multifocal da córnea com bordas hifadas
- perineurite da córnea
- ceratite intersticial
Other diagnostic factors
- vermelhidão
- dor
- lacrimejamento elevado
- edema da pálpebra
- secreção
- acuidade visual reduzida
- fotofobia
- pressão intraocular alta
- história de infecção por vírus do herpes simples ou vírus da varicela-zóster
- múltiplas cicatrizes estromais antigas
- transiluminação da íris
- hipoestesia da córnea
Risk factors
- uso de lentes de contato
- trauma corneano
- erosão/abrasão da córnea
- erosões recorrentes da córnea
- imunocomprometimento
- história de doença autoimune
- triquíase
- blefarite
- olho seco
- função deficiente da pálpebra
- doença herpética prévia
- ceratite por exposição
- exposição a água contaminada
- uso de corticosteroides tópicos
- uso de anestesia tópica
- cirurgia prévia do olho
Diagnostic tests
1st tests to order
- raspagem da córnea: microscopia de lâmina
- raspagem da córnea: culturas e sensibilidade
Tests to consider
- Hemograma completo
- teste de HIV
- testes para doenças autoimunes
- raspagem da córnea: teste de reação em cadeia da polimerase
Treatment algorithm
bacteriana (presumida): alto risco
bacteriana
herpética
fúngica
por protozoário (Acanthamoeba)
ceratite não infecciosa
infecção herpética recorrente
visão prejudicada por cicatrização da córnea
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.
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
- Abrasão da córnea
- Ceratoconjuntivite vernal com úlcera em escudo
- Olho seco ou ceratite por exposição
More DifferentialsGuidelines
- Bacterial keratitis preferred practice pattern
- Cornea/external disease summary benchmarks - 2023
More GuidelinesPatient information
Herpes-zóster: o que é?
Infecção ocular por herpes simples
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer