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Contact Lens-Associated Microbial Keratitis
Contact Lens-Associated Microbial Keratitis
Bacterial keratitis
Fungal keratitis
Herpes keratitis
Bacteri
al
Bacterial
Cause
Contact lens use, especially extended-wear
lenses(overnight), contaminated contact lenses and poor
hygiene
Contaminated water (swimming or bathing)
Use of contaminated eye medicine or other solution
appliedto the eye
Use of topical steroids
Recent corneal disease
Reduced immunity due to diabetes, alcoholism or
poornutrition
Pseudomonas keratitis
- more virulent and hence vision-threatening
- contains enzymes that can digest the cornea
-intense inflammatory infiltrate
ocular pain
redness
tearing
photophobia
blurred vision
mucopurulent discharge
Treatment
Prevent possible blindness.
Refer to ophthalmologist corneal scrapping for
gram stain
Antibiotic drops
Topical steroid
Contact Lens-Related
Herpes simplex
Infection
Herpes keratitis
Herpes keratitis is a viral infection of the eye caused by the
herpes simplex virus (HSV).
Type I is the most common and primarily infects the face,
causing the familiar "cold sore" or "fever blister."
Type II is the sexually transmitted form of herpes, infecting
the genitals.
Transmission
Type I herpes is very contagious and is commonly
transmitted by skin contact with someone who has
the virus
Infection can be transferred to the eye by touching
an active lesion (a cold sore or blister) and then
your eye.
Risk factors
After the original infection, the virus lies in a dormant state, living in
nerve cells of the skin or eye. Reactivation can be triggered in a
number of ways, including:
Stress
Sun exposure
Fever
Trauma to the body (such as injury or surgery)
Menstruation
Certain medications
Once herpes simplex is present in the eye, it typically infects the
eyelids, conjunctiva and cornea. It may also infect the inside of the
eye
DIAGNOSIS
Diagnosis of HSV is usually made clinically,
however, definitive diagnosis can be made using
tissue culture or serum antigen detection
techniques.
Treatment
Most cases of herpes simplex virus (HSV) epithelial
keratitis resolve spontaneously within 3 weeks, the
rationale for treatment is to minimize stromal damage
and scarring. Gentle epithelial debridement may be
performed to remove infectious virus and viral antigens
that may induce stromal keratitis. Antiviral therapy,
topical or oral, is an effective treatment for epithelial
herpes infection
Mild infection is typically treated with topical and
sometimes oral antiviral medication
severe scarring and vision loss, a corneal transplant may
be required.
Medical treatment
anciclovir ophthalmic gel 0.15% - 5 times daily
Trifluridine 1% drops - 9 times daily
Vidarabine 3% ointment - 5 times daily
Oral acyclovir 400 mg - 5 times daily for 10 days [19];
oral acyclovir is the preferred treatment in patients
unable to tolerate topical medications and with good
renal function
A cycloplegic agent may be added to any of the above
regimens for comfort from ciliary spasm.
Early diagnosis
diagnosis : difficulty in establishing the clinical diagnosis,
isolating the etiologic fungal organism in the laboratory
treatment : well response to topical antifungal agents
Delay diagnosis
diagnosis : easily detect from clinical presentation
treatment : poor corneal penetration of antifungal agents
Fungal keratitis
Acanthamoeba keratitis