Pearls and paradigms in Infective Keratitis

Abstract

Infective Keratitis is a commonly encountered sight-threatening ocular emergency. In developing countries, it is a major cause of corneal blindness. Empirical treatment without microbiological work up often leads to treatment failure. Indiscriminate use of steroid antibiotic combination worsens the situation and makes further management challenging. The correct line of management can be potentially sight saving for both the ophthalmologist and the patient. This article on Infective keratitis has been written keeping best practices and protocols in mind. In a very simple and concise form, it focuses on the salient features of clinical presentation of infective keratitis and the stepwise approach to subsequent management in a patient. It explains in detail the way to perform corneal scraping, the importance of the same and further management based on microbiologically proven result. The management part includes indications and methods for medical as well as surgical intervention. We aimed to share our experience in the management of patients presenting with infective keratitis in the clinic.

Keywords: bacterial; culture; infective keratitis; management; microbiology; staining; treatment.

Fig. 1

Slit Lamp photo of a patient presenting with infective keratitis

Fig. 2

Clinical documentation with the help of color-coding

Fig. 3

Various Gram stains used for diagnosis

Fig. 4

10% KOH wet mount used for diagnosis

Fig. 5

Various culture medias used in microbiology workup

Fig. 6

Bacterial keratitis leading to impending perforation treated with limbus-to-limbus keratoplasty (A) shows the pre operative picture (B) shows the postoperative picture (C) Non resolving fungal keratitis (D) therapeutic keratoplasty done for the same patient