Keratitis

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Inflammation of the cornea.

Cause

• Infection: Bacterial, viral, or fungal; leading to corneal ulceration
• Trauma: Chemical, foreign bodies

Clinical features

• Redness and tearing
• Fear of light
• Cornea is not clear and will stain with fluorescein in the case of corneal ulcer (pattern of staining depends on the causative agent, for example dendritic in viral keratitis)
• Visual acuity is usually reduced
• Condition is often unilateral
• The eye is painful

Investigations (where facilities are available)

• Full ocular examination
• Fluorescein stain to confirm diagnosis
• Pus swab for gram stain, culture and sensitivity
• Corneal scraping for microscopy, culture and sensitivity

ManagementTreatment

Admission is mandatory for young children, one- eyed patients, non-improvement after 72 hours of treatment, large ulcers (>4 mm diameter), associated occular complications such as hypopion or scleritis

Treat the specific cause

• If bacterial, apply gentamicin eye drops alternately with chloramphenicol eye drops 1–2 hourly until infection is controlled
• If viral, acyclovir eye ointment 5 times daily for herpes simplex and viral keratitis
• If fungal, natamycin ophthalmic suspension 5%
• Or econazole eye drops
  • Supportive treatment
• Atropine eye drops to relieve pain
• Vitamin A capsules for children
• Surgery may be necessary in some circumstances (i.e. conjunctival flap and tarsorrhaphy)
• Debridement (chemical/ mechanical)

Caution - DO NOT use topical cortcosteroids in patients with infective keratitis