keratitis
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Introduction
Inflammation of the cornea.
Etiology
- infection
- viral
- Herpes simplex (trigeminal)
- Varicella-zoster
- bacterial
- Staphylococcal species
- Pseudomonas aeruginosa
- especially in intubated ICU patients
- bluish or green mucopurulent discharge is almost pathognomonic for P aeruginosa[4]
- Streptococcus pneumoniae
- Moraxella
- tuberculosis[7]
- syphilis[7]
- Microsporidia
- fungi - Fusarium, Aspergillus, & Candida
- viral
- autoimmune disease
- Cogan's syndrome[7]
- trauma
- use of contact lenses[3][6], Fusarium Epidemioloogy:
- ~ 1 million healthcare visits are made annually, costing nearly $200 million (2014)[6]
Pathology
- inflammation of the cornea
- complications
- stromal ulceration
- neovascularization
- perforation
- generally limited to eye
Clinical manifestations
- photophobia
- eye pain
- foreign body sensation
- blurry vision
- redness of the eye around the sclera & cornea (ciliary flush)
- vesicles on the side or tip of the nose may occur (nasociliary nerve supplies sensory input to the nose & cornea)
- white corneal opacities may occur with bacterial keratitis
- eye discharge
- lacrimation
Laboratory
- slit lamp examination for dendritic corneal changes
Complications
- antibiotic resistant with acyclovir prophylaxis for recurrent Herpes simplex keratitis[5]
Management
- referral to an ophthalmologist to prevent loss of vision
- remove contact lens
- do NOT place patch over infected eye
- Herpes simplex responds to antiviral therapy
- fungal keratitis responds to antifungal agents
- epithelial debridement for Microsporidial keratitis
More general terms
More specific terms
- autosomal dominant keratitis
- corneal dendrite
- corneal pseudodendrite
- Herpes simplex keratitis; dendritic keratitis
- interstitial keratitis (IK)
- keratoconjunctivitis
- photokeratitis; ultraviolet keratitis; snow blindness
- superior punctate keratitis (SPK)
Additional terms
References
- ↑ Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 18, 19. American College of Physicians, Philadelphia 1998, 2018, 2022
- ↑ 3.0 3.1 Prescriber's Letter 13(5): 2006 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220507&pb=PRL Fungal keratitis infections related to contact lens use (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 eMedicine: Corneal Ulceration and Ulcerative Keratitis http://www.emedicine.com/emerg/topic115.htm
- ↑ 5.0 5.1 van Velzen M et al. Acyclovir prophylaxis predisposes to antiviral-resistant recurrent herpetic keratitis. J Infect Dis 2013 Nov 1; 208:1359. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23901090 <Internet> http://jid.oxfordjournals.org/content/208/9/1359
James SH and Prichard MN. A possible pitfall in acyclovir prophylaxis for recurrent herpetic keratitis? J Infect Dis 2013 Nov 1; 208:1353 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23901076 <Internet> http://jid.oxfordjournals.org/content/208/9/1353 - ↑ 6.0 6.1 6.2 Collier SA et al Estimated Burden of Keratitis - United States, 2010 MMWR. Weekly. November 14, 2014 / 63(45);1027-1030 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6345a3.htm
- ↑ 7.0 7.1 7.2 7.3 7.4 Rodrigues-Barros S, Parreira S Interstitial Keratitis in Cogan's syndrome Syndrome. N Engl J Med 2018; 378:852 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29490187 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1709103
- ↑ 8.0 8.1 Soifer M, Wisely CE, Carlson AN In Vivo Confocal Microscopy Evaluation of Microbial Keratitis. JAMA Ophthalmology, 2021 August 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34436512 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2783397
JAMA Ophthalmology Clinical Challenge. JN Learning https://edhub.ama-assn.org/jn-learning/module/2783397 - ↑ Lin A, Rhee MK, Akpek EK, et al; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Bacterial keratitis Preferred Practice Pattern. Ophthalmology. 2019;126:P1-P55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30366799