Distinguishing infective versus noninfective keratitis

Abstract

For the purpose of this symposium, the term "keratitis" implies suppurative nonviral and viral keratitis. Corneal ulcers have been described in ancient literature. But even today, despite the availability of a wide range of newer antimicrobials and new diagnostic techniques, infective keratitis continues to pose a diagnostic and therapeutic challenge. This article focuses on the key diagnostic clinical features of the most common organisms causing infective keratitis - bacteria, fungi, viruses, nocardia and acanthamoeba - in India. While the clinical features in some cases are fairly straightforward, most cases challenge the clinician. We describe the salient clinical features which can help arrive at a diagnosis to begin appropriate treatment immediately, prior to the laboratory report.

Figure 1

Mooren ulcer with perforation

Figure 2

Shield ulcer with plaque

Figure 3

Marginal keratitis

Figure 4

Mooren ulcer

Figure 5

Bacterial ulcer (Pneumococcal)

Figure 6

Nocardial keratitis

Figure 7

Neurotrophic sterile ulcer

Figure 8

Pigmented fungal ulcer

Figure 9

Early fungal keratitis

Figure 10

Acanthamoeba keratitis