One Liners about Keratitis

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Keratitis

Causes:

  1. MC cause of bacterial keratitis in India: Streptococus pneumoniae
  2. MC cause of bacterial keratitis in world: Pseudomonas
  3. MC cause of fungal keratitis: Aspergillus fumigatus
  4. MC cause of keratitis in contact lens users: Pseudomonas
  5. Most specific cause of keratitis in contact lens users: Acanthamoeba.

 

Signs & symptoms:

  • 1st symptom of any type of keratitis: Photophobia
  • Double immune ring of Wesley is seen in fungal > acanthamoeba keratitis

  • Salmon patch sign/ Hutchinson patch sign: Seen in congenital syphilis.

Treatment options:

Type of keratitis DOC
Fungal Natamycin
Acanthamoeba Polyhexamethylene Biguanide (PHMB)
HSV Antiviral
Pseudomonas Cefazolin + Tobramycin

 

Herpes simplex keratitis:

  1. Decreased corneal sensation is the hallmark of viral keratitis
  2. Appearance of HSV keratitis affecting epithelium:
    • Fluorescein stain: Cornea appears green
    • Rose bengal stain: Cornea appears red/ pink
  3. Interstitial keratitis is type 3 hypersensitivity
  4. Disciform (endothelial) keratitis is type 4 (delayed) hypersensitivity
  5. Treatment of herpetic keratitis:
  • Overall DOC: Antiviral (Acyclovir/ Idoxuridine)
  • Steroids are C/I in dendritic ulcer since it will lead to formation of geographic ulcer
  • Steroid can be given in disciform keratitis though but under antiviral cover.

 

Neurotrophic & Neuroparalytic keratitis:

  1. Neuroparalytic keratitis: Impairment of corneal innervation by facial nerve (motor) → Paralytic symptoms
  2. Neurotrophic keratitis: Impairment of corneal innervation by trigeminal nerve (sensory) → Reduction/ absence of corneal sensitivity
  3. Cenegermin: It is the first drug to treat neurotrophic keratitis. It is a recombinant form of human nerve growth factor that stimulates growth and survival of corneal epithelial cells.

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