1. Bacterial Keratitis

الرحيم الرحمن الله بسم

Bacterial Keratitis

Risk factors Risk factors كوتكوتContact lensesContact lenses

Ocular surface disease > Herpetic kerattisOcular surface disease > Herpetic kerattisOthers > D.M.Others > D.M.

TraumaTrauma

Bacterial Keratitis

SymptomsSymptomsForeign body sensation ; photophobia ; blurred Foreign body sensation ; photophobia ; blurred

vision ; dischargevision ; discharge

Bacterial Keratitis

SignsSignsEpithelial defectEpithelial defect

Stromal edema + folds of basement membrane + Stromal edema + folds of basement membrane + anterior uveitis + small hypopyonanterior uveitis + small hypopyon

Lid and conjunctival edemaLid and conjunctival edemaLarge hypopyonLarge hypopyon

PerforationPerforationEndophthalmitisEndophthalmitis

Scleritis Scleritis ScarringScarring

Bacterial Keratitis

DdxDdxOther infectionsOther infections

Marginal and sterial inflammation due to contact Marginal and sterial inflammation due to contact lenselense

Bacterial Keratitis

TreatmentTreatmentAntibioticsAntibioticsMydriatics Mydriatics

steriodssteriods

Bacterial Keratitis

TreatmentTreatmentAntibioticsAntibiotics

TopicalTopicalSubconjunctivalSubconjunctival

Oral Oral

Bacterial Keratitis

TreatmentTreatment1. Antibiotics1. Antibioticsa. Topical antibiotics ( cefuroxime + gentamicin ) a. Topical antibiotics ( cefuroxime + gentamicin ) b. Subconjunctival antibiotics indicated in poor b. Subconjunctival antibiotics indicated in poor

complaincecomplaincec. Oral antibiotics indicatinsc. Oral antibiotics indicatins1. Ulceration1. Ulceration2. Perforation2. Perforation3. Systemic manifestation3. Systemic manifestation

Bacterial Keratitis

TreatmentTreatment2. Topical Mydriatics for 2. Topical Mydriatics for 1. pain1. pain2. prevention of posterior synechiae2. prevention of posterior synechiae

Bacterial Keratitis

TreatmentTreatment3.Topical steriods ( after excluding fungal or viral 3.Topical steriods ( after excluding fungal or viral

keratitis ) for keratitis ) for 1. making the illness more comfortable1. making the illness more comfortable2. prevent rejection of corneal graft2. prevent rejection of corneal graft

Bacterial Keratitis

Failure of RxFailure of RxWrong DxWrong DxWrong RxWrong Rx

Gram – ulcersGram – ulcersDrug toxicityDrug toxicity

Bacterial Keratitis

Bacterial Keratitis

Marginal Bacterial keratitis

Size < 1 mm > 1 mm

Location Peripheral Central

Epithelial damage

No Yes

Uveitis No Yes