KERATITIS

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