Keratitis

Question 1

Why is keratitis more serious than conjunctivitis?

Answer 1

It is potentially sight threatening

Question 2

What are the features of keratitis?

Answer 2

Painful red eye
Foreign body, gritty sensation
Photophobia

Hypopyon (pus) may be seen

Question 3

What are some causes of keratitis?

Answer 3

Viral:
Herpes simplex virus (HSV)

Bacterial:
Staph. aureus
Pseudomonas aeroginosa (in contact lens wearers)

Fungal:
Candida
Aspergillus

Environmental:
Contact lens acute red eye (CLARE)
Exposure keratitis (due to inadequate eyelids coverage)

Question 4

What symptoms can occur in herpes simplex keratitis?

Answer 4

Painful, red eye
Photophobia
Watery eye
Foreign body sensation
Reduced VA - subtle or significant

Question 5

What investigations are carried out to diagnose herpes simplex keratitis?

Answer 5

Slit lamp examination with fluorescein staining:
Under cobalt-blue filter will show dendritic ulcer

Corneal swabs or scrapings

Question 6

What is the treatment for herpes simplex keratitis?

Answer 6

Immediate referral to ophthalmologist
Topical aciclovir
Topical steroids if they have stromal keratitis (inflammation of stroma)

Question 7

What are the complications of keratitis?

Answer 7

Corneal scarring
Perforation
Endopthalmitis
Visual loss

Question 8

What is the management for keratitis?

Answer 8

Same-day referral to ophthalmologist if contact lens wearer

Stop wearing contact lens

Bacterial keratitis - topical broad-spectrum Abx e.g. levofloxacin or moxifloxacin