- MC cause of bacterial keratitis in India: Streptococus pneumoniae
- MC cause of bacterial keratitis in world: Pseudomonas
- MC cause of fungal keratitis: Aspergillus fumigatus
- MC cause of keratitis in contact lens users: Pseudomonas
- 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.
|Type of keratitis||DOC|
|Acanthamoeba||Polyhexamethylene Biguanide (PHMB)|
|Pseudomonas||Cefazolin + Tobramycin|
Herpes simplex keratitis:
- Decreased corneal sensation is the hallmark of viral keratitis
- Appearance of HSV keratitis affecting epithelium:
- Fluorescein stain: Cornea appears green
- Rose bengal stain: Cornea appears red/ pink
- Interstitial keratitis is type 3 hypersensitivity
- Disciform (endothelial) keratitis is type 4 (delayed) hypersensitivity
- 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:
- Neuroparalytic keratitis: Impairment of corneal innervation by facial nerve (motor) → Paralytic symptoms
- Neurotrophic keratitis: Impairment of corneal innervation by trigeminal nerve (sensory) → Reduction/ absence of corneal sensitivity
- 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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