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keratitis

Inflammation of the cornea. Etiology: 1) infection a) viral 1] Herpes simplex (trigeminal) 2] Varicella-zoster b) bacterial - Staphylococcal species - Pseudomonas aeruginosa 1] especially in intubated ICU patients 2] bluish or green mucopurulent discharge is almost pathognomonic for P aeruginosa [4] - Streptococcus pneumoniae - Moraxella - tuberculosis [7] - syphilis [7] c) Microsporidia d) fungi - Fusarium, Aspergillus, & Candida 2) autoimmune disease 3) Cogan's syndrome [7] 4) trauma 5) 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 a) stromal ulceration b) neovascularization c) perforation - generally limited to eye Clinical manifestations: 1) photophobia 2) eye pain 3) foreign body sensation 4) blurry vision 5) redness of the eye around the sclera & cornea (ciliary flush) 6) vesicles on the side or tip of the nose may occur (nasociliary nerve supplies sensory input to the nose & cornea) 7) white corneal opacities may occur with bacterial keratitis 8) eye discharge 9) lacrimation * image [7,8] Laboratory: - slit lamp examination for dendritic corneal changes Complications: - antibiotic resistant with acyclovir prophylaxis for recurrent Herpes simplex keratitis [5] Management: 1) referral to an ophthalmologist to prevent loss of vision a) remove contact lens b) do NOT place patch over infected eye 2) Herpes simplex responds to antiviral therapy 3) fungal keratitis responds to antifungal agents 4) epithelial debridement for Microsporidial keratitis

Related

ciliary flush nasociliary nerve

Specific

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)

General

corneal disease (keratopathy) eye infection (ocular inflammation including eyelid inflammation)

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 18, 19. American College of Physicians, Philadelphia 1998, 2018, 2022
  3. Prescriber's Letter 13(5): 2006 Detail-Document#: 220507 Fungal keratitis infections related to contact lens use (subscription needed) http://www.prescribersletter.com
  4. eMedicine: Corneal Ulceration and Ulcerative Keratitis http://www.emedicine.com/emerg/topic115.htm
  5. van Velzen M et al. Acyclovir prophylaxis predisposes to antiviral-resistant recurrent herpetic keratitis. J Infect Dis 2013 Nov 1; 208:1359. PMID: 23901090 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 PMID: 23901076 http://jid.oxfordjournals.org/content/208/9/1353
  6. 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. Rodrigues-Barros S, Parreira S Interstitial Keratitis in Cogan's syndrome Syndrome. N Engl J Med 2018; 378:852 PMID: 29490187 http://www.nejm.org/doi/full/10.1056/NEJMicm1709103
  8. Soifer M, Wisely CE, Carlson AN In Vivo Confocal Microscopy Evaluation of Microbial Keratitis. JAMA Ophthalmology, 2021 August 26 PMID: 34436512 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2783397 - JAMA Ophthalmology Clinical Challenge. JN Learning https://edhub.ama-assn.org/jn-learning/module/2783397
  9. 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: 30366799