Dr.

Imran Ahmad
MBBS. FICO. FCPS. MRCS.Ed
Anatomy of cornea
Bacterial kerititis develops when ocular defences have
been compromised
N. Gonorrhoeae, N. meningitidis, C.Diphtheria and
H. Influenza are able to penetrate a normal corneal
epithelium.
The most common pathogens are Pseudomonas
aerugenosa, staphylococcus aureus, strep. Pyogenes
and strep. Pneumoniae.
Risk factors:
Contact lens wear:
 Corneal epithelium compromise secondary to hypoxia and
minor trauma
 Poor contact lens hygiene

Trauma
 Refractive surgery, vegetative trauma
Ocular surface disease
 Herpetic kerititis, bullous keratopathy, dry eyes, chronic
blepheritis, trichiasis, entropion.
Other factors
 Systemic immunosupression, DM, Vit A deficiency
Clinical Features
Presentation is with pain, photophobia, blurred
vision and mucopurulent discharge.
Epithelial defect associated with infiltrate
Enlargement of infiltrate and epithelial defect
Stromal edema, folds in descemet membrane and
anterior uveitis
Chemosis and eyelid swelling in severe cases
Rapid progression of infiltration with an enlarging
hypopyon
Severe ulceration may lead to perforation
Scarring, vascularization and opacification
Corneal sensations will be reduced in associated
herpetic kerititis
Differential diagnosis:
Fungal kerititis
Herpes simplex kerititis
Acanthamoeba kerititis
Marginal kerititis
Investigations
Corneal scrapping
Conjunctival swabs
Contact lens cases
Gram staining
Treatment
General consideration:
Hospital admission
 In non-compliant patients or in patients with only eye
Discontinuation of contact lens wear
A clear plastic eye shield
 In cases of thinning or perforation
Decision to treat:
 Broad spectrum antibiotics should be started before results
of sensitivity are available
Local therapy:
 Antibiotic monotherapy:
 Flouroquinolones are the usual choice
 Antibiotic dual therapy
 It is preferred in aggressive diseases and include two fortified
antibiotics like cephalosporin and aminoglycosides in order to
overcome both gram positive and gram negative pathogens
 Sub-conjunctival antibiotics
 Are indicated in patients with poor compliance to topical therapy
 Mydriatics
 Like atropine or cyclopen are used to prevent formation of posterior
syneche and to reduce pain
Steroids are contraindicated in corneal ulceration
Systemic antibiotics
Systemic antibiotics are not usually given but are
given in following circumstances
Potential for systemic involvement:
In cases of N. meningitidis, H. ifluenza, N. gonorrhoeae
Severe corneal thinning
With threatened or actual perforation
Scleral involvement
Treatment failure
If no improvement in 24-48 hrs of intensive therapy,
the antibiotics regimen should be reviewed.
There is no need to change therapy if it produces
favorable results, even if culture shows resistant
organisms
If still no improvement after 48 hrs of changing
antibiotics then treatment should be suspended for 24
hrs and re-scrapping done again.
Penetrating keratoplasty should be done in resistant
cases to medical therapy.
Thank You