Acute Keratitis

Introduction

Acute Keratitis is an infection or inflammation of the cornea. It could be secondary to trauma to the cornea and is sometimes associated with infective
conjunctivitis but could occur de novo.

Clinical features

  • Irritation, pain
  • Red eye (conjunctival congestion)
  • Eye discharge: watery; purulent (if bacterial)
  • Photophobia
  • Visual impairment, depending on the site and size of ulcer and if interstitial
  • Hypopion, if associated with uveitis (no hypopion if viral)
  • Ulceration of cornea, which stains with fluorescene; no ulcer in interstitial keratitis

Aetiology

Exogenous

  • Marginal ulcers secondary to bacterial conjunctivitis (S. aureus)
  • Central ulcers (Pneumococcus, Herpes simplex, fungi)

Keratomalacia (Vitamin A deficiency)
Exposure (7th cranial nerve palsy or
dysthyroid eye disease)
Endogenous

  • Interstitial keratitis of congenital syphilis
  • Interstitial keratitis of Herpes zoster

Differential diagnoses

  • Infective conjunctivitis
  • Acute iritis
  • Acute glaucoma

Complications

  • Corneal perforation

Investigation

Corneal scraping for microscopy, culture and sensitivity

Drug treatment

Antibiotic drops (if bacterial)
Chloramphenicol eye drops 0.5%

  • Apply 1 drop at least every 2 hours, and then reduce the frequency as infection is controlled and continue for 48 hours after healing

Atropine drops

  • 1 drop 2 times daily

Antivirals (if dendritic ulcer)
conjunctiva,
Acyclovir

  • Apply 1 cm ointment 5 times daily( continue for at least 3 days after complete healing

Idoxuridine 5% in dimethylsulfoxide

  • Adult and child over 12 years: apply to lesions 4 times daily for 4 days, starting at first sign of attack
  • Child under 12 years: not recommended

Topical steroids

  • Only for interstitial keratitis where there is no active ulcer.

Non-drug measures

  • Lateral tarsorrhaphy for exposure
    keratopathy

Caution and contraindications to treatment

  • Never use topical steroids in the presence of an active ulcer

Prevention

  • Treat initial infection or trauma promptly to avoid progression to keratitis