Highlights & Basics
- Keratitis is an ocular emergency and remains one of the major causes of blindness around the world.
- Main risk factors include corneal trauma, contact lens wear, and breakdown of the corneal epithelium.
- The diagnosis depends on a careful history, slit-lamp examination, and corneal scraping cultures.
- Treatment consists of topical antimicrobial agents that may be supplemented by pupil-dilating agents, analgesics, corticosteroids, and systemic antimicrobials as needed.
- Complications include corneal scarring, perforation, and endophthalmitis.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
Rhee MK, Ahmad S, Amescua G, et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P87-133.[Full Text]
Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;(10):CD005430.[Abstract][Full Text]
Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;(1):CD002898.[Abstract][Full Text]
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27. Tauber J, Sainz de la Maza M, Hoang-Xuan T, et al. An analysis of therapeutic decision making regarding immunosuppressive chemotherapy for peripheral ulcerative keratitis. Cornea. 1990 Jan;9(1):66-73.[Abstract]
28. Lin A, Ahmad S, Amescua G, et al. Blepharitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P50-86.
29. Narayanan S, Redfern RL, Miller WL, et al. Dry eye disease and microbial keratitis: is there a connection? Ocul Surf. 2013 Apr;11(2):75-92.[Abstract][Full Text]
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31. Jacobs DS, Lee JK, Shen TT, et al. Refractive surgery preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P61-135.[Full Text]
32. Austin A, Lietman T, Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology. 2017 Nov;124(11):1678-89.[Full Text]
33. Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;(10):CD005430.[Abstract][Full Text]
34. Srinivasan M, Mascarenhas J, Rajaraman R, et al; Steroids for Corneal Ulcers Trial Group. Corticosteroids for bacterial keratitis: the Steroids for Corneal Ulcers Trial (SCUT). Arch Ophthalmol. 2012 Feb;130(2):143-50.[Abstract][Full Text]
35. Lalitha P, Srinivasan M, Rajaraman R, et al. Nocardia keratitis: clinical course and effect of corticosteroids. Am J Ophthalmol. 2012 Dec;154(6):934-9.[Abstract]
36. Garg P, Vazirani J. Can we apply the results of the Steroid Corneal Ulcer Trial to Nocardia infections of the cornea? Expert Rev Ophthalmol. 2013;8:41-4.
37. Hanet MS, Jamart J, Chaves AP. Fluoroquinolones or fortified antibiotics for treating bacterial keratitis: systematic review and meta-analysis of comparative studies. Can J Ophthalmol. 2012 Dec;47(6):493-9.[Abstract]
38. Patterson TJ, McKinney D, Ritson J, et al. The use of preoperative prophylactic systemic antibiotics for the prevention of endopthalmitis in open globe injuries: a meta-analysis. Ophthalmol Retina. 2023 Nov;7(11):972-81.[Abstract][Full Text]
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40. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;(1):CD002898.[Abstract][Full Text]
41. Kaufman HE, Haw WH. Ganciclovir ophthalmic gel 0.15%: safety and efficacy of a new treatment for herpes simplex keratitis. Curr Eye Res. 2012 Jul;37(7):654-60.[Abstract]
42. FlorCruz NV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database Syst Rev. 2015 Apr 9;(4):CD004241.[Abstract][Full Text]
43. Raj N, Vanathi M, Ahmed NH, et al. Recent perspectives in the management of fungal keratitis. J Fungi (Basel). 2021 Oct 26;7(11):907.[Abstract][Full Text]
44. Hariprasad SM, Mieler WF, Lin TK, et al. Voriconazole in the treatment of fungal eye infections: a review of current literature. Br J Ophthalmol. 2008 Jul;92(7):871-8.[Abstract]
45. Alkharashi M, Lindsley K, Law HA, et al. Medical interventions for acanthamoeba keratitis. Cochrane Database Syst Rev. 2015 Feb 24;(2):CD010792.[Abstract][Full Text]
46. Tu EY, Joslin CE, Shoff ME. Successful treatment of chronic stromal acanthamoeba keratitis with oral voriconazole monotherapy. Cornea. 2010 Sep;29(9):1066-8.[Abstract][Full Text]
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50. Dana R, Farid M, Gupta PK, et al. Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy. BMC Ophthalmol. 2021 Sep 8;21(1):327.[Abstract][Full Text]
51. Papaioannou L, Miligkos M, Papathanassiou M. Corneal collagen cross-linking for infectious keratitis: a systematic review and meta-analysis. Cornea. 2016 Jan;35(1):62-71.[Abstract]
52. Davis SA, Bovelle R, Han G, et al. Corneal collagen cross-linking for bacterial infectious keratitis. Cochrane Database Syst Rev. 2020 Jun 17;6(6):CD013001.[Abstract][Full Text]
53. Avdagic E, Chew HF, Veldman P, et al. Resolution of Acanthamoeba keratitis with adjunctive use of oral miltefosine. Ocul Immunol Inflamm. 2021 Feb 17;29(2):278-81.[Abstract]
54. Thulasi P, Saeed HN, Rapuano CJ, et al. Oral miltefosine as salvage therapy for refractory Acanthamoeba keratitis. Am J Ophthalmol. 2021 Mar;223:75-82.[Abstract]
55. Naranjo A, Martinez JD, Miller D, et al. Systemic miltefosine as an adjunct treatment of progressive Acanthamoeba keratitis. Ocul Immunol Inflamm. 2021 Nov 17;29(7-8):1576-84.[Abstract]
56. de la Presa M, Ibach M, Berdahl J, et al. Anterior scleral and limbal inflammatory necrosis after adjuvant miltefosine for recalcitrant acanthamoeba keratitis. Cornea. 2022 Jun 1;41(6):775-8.[Abstract]
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58. Keay L, Edwards K, Naduvilath T, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology. 2006 Jan;113(1):109-16.[Abstract]
59. Ti SE, Scott JA, Janardhanan P, et al. Therapeutic keratoplasty for advanced suppurative keratitis. Am J Ophthalmol. 2007 May;143(5):755-62.[Abstract]
60. Iyer SA, Tuli SS, Wagoner RC. Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens. 2006 Dec;32(6):267-71.[Abstract]
61. Labetoulle M, Auquier P, Conrad H, et al. Incidence of herpes simplex virus keratitis in France. Ophthalmology. 2005 May;112(5):888-95.[Abstract]
62. Branco BC, Gaudio PA, Margolis TP. Epidemiology and molecular analysis of herpes simplex keratitis requiring primary penetrating keratoplasty. Br J Ophthalmol. 2004 Oct;88(10):1285-8.[Abstract]
63. Thebpatiphat N, Hammersmith KM, Rocha FN, et al. Acanthamoeba keratitis: a parasite on the rise. Cornea. 2007 Jul;26(6):701-6.[Abstract]
64. Bhatt UK, Abdul Karim MN, Prydal JI, et al. Oral antivirals for preventing recurrent herpes simplex keratitis in people with corneal grafts. Cochrane Database Syst Rev. 2016 Nov 30;(11):CD007824.[Abstract][Full Text]
