Inflammation of the cornea.
Causes
- Infection: Bacterial, viral, or fungal; leading to corneal ulceration
- Trauma: Chemical, foreign bodies
Clinical features
- Redness and tearing
- Fear of light
- Cornea is not clear and will stain with fluorescein in the case of corneal ulcer (pattern of staining depends on the causative agent, for example dendritic in viral keratitis)
- Visual acuity is usually reduced
- Condition is often unilateral
- The eye is painful
Investigations (where facilities are available)
- Full ocular examination
- luorescein stain to confirm diagnosis
- Pus swab for gram stain, culture and sensitivity
- Corneal scraping for microscopy, culture and sensitivity
MANAGEMENT
- Admission is mandatory for young children, one eyed patients, non-improvement after 72 hours
of treatment, large ulcers (>4 mm diameter), associated occular complications such as
hypopion or scleritis
Treat the specific cause
- If bacterial, apply gentamicin eye drops alternately with chloramphenicol eye drops
1–2 hourly until infection is controlled - If viral, acyclovir eye ointment 5 times daily for herpes simplex and viral keratitis
- If fungal, natamycin ophthalmic suspension 5%
- Or econazole eye drops
- Supportive treatment
- Atropine eye drops to relieve pain
- Vitamin A capsules for children
- Surgery may be necessary in some circumstances i.e. conjunctival flap and tarsorrhaphy
- Debridement (chemical/ mechanical)
Caution
- DO NOT use topical corticosteroids in patients with infective keratitis