Original articleUpdate on the Management of Infectious Keratitis
Section snippets
Diagnostics
Proper diagnosis of keratitis is essential to determining treatment and achieving resolution of infection. The mainstay in diagnosis is still Gram stain and culture of corneal samples despite imperfect sensitivity.13, 14, 15 Gram and Giemsa stains are advantageous because they provide instant results, with Gram stain accurately detecting the causative organism 60% to 75% of the time in bacterial cases and 35% to 90% in fungal cases. Giemsa has a sensitivity of 40% to 85% for diagnosing fungal
Bacterial Keratitis
In the United States, bacterial keratitis is most associated with contact lens use.19 Severe cases can progress rapidly and cause permanent vision loss requiring corneal transplantation.
Fungal Keratitis
Fungal ulcers often have worse outcomes than bacterial ulcers, and there is little evidence to guide treatment.66 Fungal keratitis represents a relatively small percentage of infectious keratitis cases in regions with temperate climates; however, in tropical climates it can cause up to 50% of infectious ulcers.66, 67, 68 Contact lens wear has been identified as a risk factor for fungal keratitis in the United States, and an outbreak of Fusarium keratitis among contact lens wearers was related
Viral Keratitis
Herpes simplex virus (HSV) keratitis affects an estimated 500 000 people in the United States and an estimated 1.5 million globally.91 It is the most common cause of unilateral infectious corneal blindness in much of the developed world.92 Viral keratitis differs from bacterial and fungal keratitis in that it can become chronic and recurrent. Besides being a painful, sight-threatening infection, HSV keratitis has been shown to significantly affect quality of life even when patients are not
Next-Generation Sequencing
Culture-negative keratitis remains a significant problem for clinicians. At Aravind Eye Hospital in India, for example, 38% of corneal scrapings from eyes with presumed infectious keratitis tested negative on both culture and smear between 2002 and 2012.105 Next-generation sequencing may improve on the diagnostic accuracy of infectious keratitis, particularly for organisms that are difficult to culture by conventional methods, such as atypical or anaerobic bacteria.106 Next-generation
Conclusions
Despite having appropriate antimicrobial treatments for most of the pathogens implicated in infectious keratitis, clinical outcomes often are poor. Strategies to reduce the morbidity associated with this condition are likely going to have to be multidimensional, involving corneal ulcer prevention, improved early and accurate diagnostics techniques such as next-generation sequencing, and novel antimicrobial agents to address the development of drug resistance. Adjuvant therapies that focus on
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Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by grant no. K23 EY025025 (J.R.-N.), an unrestricted grant from the Peirles Foundation (J.R.-N.), and an unrestricted grant from Research to Prevent Blindness (J.R.-N.).
Author Contributions:
Conception and design: Austin, Lietman, Rose-Nussbaumer
Data collection: Austin
Analysis and interpretation: Austin, Lietman, Rose-Nussbaumer
Obtained funding: Not applicable
Overall responsibility: Austin, Lietman, Rose-Nussbaumer