Keratitis: Difference between revisions

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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Viral keratitis}}
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''No treatment, but if symptomatic, use cold artificial tears'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Herpes simplex]]'''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trifluridine]] eye drops, q1-2 hours up to 9 drops/day until re-epithelialization, then one drop q4h for a total course up to 21 days'''''
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Varicella-zoster]]'''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Famciclovir]] 500 mg po tid  x 10 days'''''<BR>''OR''<BR>▸ '''''[[Valacyclovir]] 1 gm po tid x 10 days'''''
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Herpes simplex]]'''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vidarabine]] ointment 5 times per day x 21 days (currently discontinued in U.S.)'''''
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Varicella-zoster]]'''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Acyclovir]] 800 mg po 5 times/day x 10 days'''''
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Revision as of 21:05, 6 February 2014

Template:DiseaseDisorder infobox Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Keratitis is a condition in which the eye's cornea is inflamed.

Types

Superficial keratitis involves the superficial layers of the cornea. After healing, this form of keratitis does not generally leave a scar.

Deep keratitis involves deeper layers of the cornea, leaving a scar upon healing that impairs vision if on or near the visual axis.

Causes

Keratitis has multiple causes, one of which is an infection of a present or previous herpes simplex virus secondary to an upper respiratory infection, involving cold sores.

Pathogens

  • Amoebic keratitis. Amoebic infection of the cornea is the most serious corneal infection, usually affecting soft contact lens wearers. It is usually caused by Acanthamoeba. On May 25, 2007, the CDC issued a health advisory due to increased risk of Acanthamoeba keratitis (AK)infection associated with use of Advanced Medical Optics (AMO) Complete Moisture Plus Multi-Purpose eye solution. See CDC Advisory
  • Bacterial keratitis. Bacterial infection of the cornea can follow from an injury or from wearing contact lenses. The bacteriums usually involved are Staphylococcus aureus and for contact lens wearers Pseudomonas aeruginosa.
  • Fungal keratitis (cf. Fusarium, causing recent incidences of keratitis through the possible vector of Bausch & Lomb ReNu with MoistureLoc contact lens solution)
  • Viral keratitis

Other

Symptoms

The symptoms are often very similar to those of conjunctivitis, an inflammation of the conjunctiva, and photophobia. The eye turns very red and there may be sensitivity to light, and the eye may feel uncomfortable. In the later stages of more severe cases, there can be strong pain, loss of vision/blurriness, and pus may form.

Diagnosis

Effective diagnosis is important in detecting this condition and subsequent treatment as keratitis is sometimes mistaken for an allergic conjunctivitis.


Treatment

Treatment depends on the cause of the keratitis.

Infectious keratitis generally requires antibacterial, antifungal, or antiviral therapy is to treat the infection. This treatment can involve prescription eye drops, pills, or even intravenous therapy. Over-the-counter eye drops are typically not helpful in treating infections. In addition, contact lens wearers are typically advised to discontinue contact lens wear and discarding contaminated contact lenses and contact lens cases. Antibacterial solutions include Quixin (levofloxacin), Zymar (gatifloxacin), Vigamox (moxifloxacin), Ocuflox (ofloxacin — available generically). Steroid containing medications should not be used for bacterial infections, as they may exacerbate the disease and lead to severe corneal ulceration and corneal perforation. These include Maxitrol (neomycin+polymyxin+dexamethasone — available generically), as well as other steroid medications. One should consult a qualified Ophthalmologist for treatment of an eye condition.

Some infections may scar the cornea to limit vision. Others may result in perforation of the cornea, endophthalmitis (an infection inside the eye), or even loss of the eye. With proper medical attention, infections can usually be successfully treated without long-term visual loss.

Bacterial Keratitis
Preferred Regimen
Acute
Moxifloxacin eye drops 1 gtt tid
Contact lens use
Ciprofloxacin 0.3% eye drops hourly x 24–72 hrs then taper based on clinical response
OR
Levofloxacin 0.5% eye drops hourly x 24–72 hrs then taper based on clinical response
Immunosuppression- diabetic
Ciprofloxacin 0.3% eye drops hourly x 24–72 hrs then taper based on clinical response
Alternative Regimen
Acute
Gatifloxacin 1-2 gtts q2h while awake x 2 days, then q4h x 3-7 days.
Contact lens use
Tobramycin 0.3% solution hourly x24–72 hrs, then taper based on clinical response
OR
Gentamicin 0.3% solution hourly x24–72 hrs, then taper based on clinical response
Immunosuppression- diabetic
Vancomycin 50 mg/mL solution hourly x24–72 hrs, then taper based on clinical response
PLUS
Ceftazidime 50 mg/mL solution hourly x24–72 hrs, then taper based on clinical response
Fungal Keratitis
Preferred Regimen
Natamycin 5% eye drops q1–2 hrs x 3-4 days, then one drop q3-4h x 14 to 21 days or until resolution of keratitis
Alternative Regimen
Amphotericin B (0.05–0.15%) eye drops, q1h, then slow taper based on clinical response
Protozoan keratitis (Acanthameba keratitis)
Chlorhexidine plus Polyhexamethylene biguanide 0.02% 1gtt q1h for first week, then subsequent taper over 3 - 4 weeks
OR
Biguanide-chlorhexidine plus propamidine 0.1 % or hexamidine 0.1 % 1gtt q1h for first week, then subsequent taper over 3 - 4 weeks[1]
Viral keratitis
Preferred Regimen Herpes simplex
Trifluridine eye drops, q1-2 hours up to 9 drops/day until re-epithelialization, then one drop q4h for a total course up to 21 days
Varicella-zoster
Famciclovir 500 mg po tid x 10 days
OR
Valacyclovir 1 gm po tid x 10 days
Alternative Regimen Herpes simplex
Vidarabine ointment 5 times per day x 21 days (currently discontinued in U.S.)
Varicella-zoster
Acyclovir 800 mg po 5 times/day x 10 days

See also

External links


de:Keratitis hr:Keratitis it:Cheratite nl:Keratitis uk:Кератит


Template:WikiDoc Sources

  1. Lim N, Goh D, Bunce C, Xing W, Fraenkel G, Poole TR; et al. (2008). "Comparison of polyhexamethylene biguanide and chlorhexidine as monotherapy agents in the treatment of Acanthamoeba keratitis". Am J Ophthalmol. 145 (1): 130–5. doi:10.1016/j.ajo.2007.08.040. PMID 17996208.