keratitis

Question 1

what is keratitis?

Answer 1

-inflammation of the cornea

Question 2

what are some different types of keratitis?

Answer 2

• bacterial keratitis
• herpetic keratitis
• adenoviral keratitis
• fingal keratitis

Question 3

what are the most common organisms to cause bacterial keratitis?

Answer 3

• staphylococcus (gram +ve)
• pseudomonas (gram -ve)
• streptococcus (gram +ve)

contact lens related tend to be gram -ve

Question 4

how does bacterial keratitis present?

Answer 4

-hypopyon (pool of WBC) in the eye

Question 5

how does bacterial keratitis present?

Answer 5

-hypopyon (pool of WBC) in the eye

Question 6

what are the investigations for bacterial keratitis?

Answer 6

-corneal scrapes

Question 7

what is the treatment for bacterial keratitis?

Answer 7

need admission for hourly drops:
-alpha 4 quinolone (ofloxacin)

For strep pneumonia:
-gentamycin +cefuroxime

Question 8

what is the most common cause of keratitis?

Answer 8

herpes simplex infection

Question 9

what is the most common cause of keratitis?

Answer 9

-herpes simplex infection

Question 10

what part of the cornea does herpes simplex usually affect in keratitis?

Answer 10

-epithelial layer of the cornea

Question 11

how does herpetic keratitis present?

Answer 11

• DENDRITIC CORNEAL ULCER
• painful red eye
• photophobia
• vesicles around the eye
• foreign body sensation
• watering eye
• reduced visual acuity (this can vary from subtle to significant)

Question 12

what investigations are done for herpetic keratitis?

Answer 12

• Flourescein staining to show dendritic corneal ulcer (dendritic describes the appearance of branching and spreading ulcer)
• slit lamp examination is required to find and diagnose keratitis
• corneal swabs or scrapings can be used to isolate the virus using a viral culture or PCR

Question 13

what is the treatment for herpetic keratitis?

Answer 13

-Antivirals such as acyclovir

Put anaesthetic in eyes as it is painful!!
NO steroids as these cause corneal melt and perforation

Question 14

why would you not use steroids in the eye to treat herpetic keratitis?

Answer 14

-as these cause corneal melt and perforation

Question 15

what causes adenoviral keratitis?

Answer 15

-adenovirus

Question 16

how does adenoviral keratitis present?

Answer 16

subepithelial infiltrates

• bilateral
• usually following URTI
• contagious

Question 17

what is the treatment for adenoviral keratitis?

Answer 17

Antivirals- acyclovir

• Can give topical AB to prevent secondary infection
• Can require steroid to speed up recovery if becomes chronic

Question 18

who is fungal keratitis common in?

Answer 18

-patients who wear contact lenses especially if they wash them in water

Question 19

what organisms cause fungal keratitis?

Answer 19

0acanthamoeba

-pseudomonas aeruginosa

Question 20

how does fungal keratitis present compared to other types of keratitis?

Answer 20

-it is less painful than others

Question 21

what is the treatment for fungal keratitis?

Answer 21

Fungal:
anti-fungal (natamycin or voriconazole drops)
-pain relief

Acanthamoeba:

• anti septics (chlorohexidine every 30 mins for 6 weeks)
• antifungal (itraconazole or voriconazole drops)

TAKES A LONG TIME TO HEAL