ATLANTIC CITY, N.J. — A practical, empirical, evidence-based approach is the best strategy for diagnosing and treating bacterial keratitis, according to a speaker here.
Eric D. Donnenfeld, MD, OSN Cornea/External Disease Board Member, presented pearls on diagnosis and management at the Current Concepts in Ophthalmology meeting.
“One of the things I always look for in bacterial keratitis is there is almost always some predisposing etiology. You as a clinician not only have to diagnose the ulcer but find out why the patient developed it, because if you know the risk factor, you know the treatment very commonly,” Donnenfeld said.
Donnenfeld recommended that clinicians take a practical, empirical approach to diagnosis and treatment.
“The practical approach is you make the diagnosis clinically with no microbiological workup. Treatment is commercially available antibiotics. You refer patients not responding under your care,” he said.
Contact lens-related infections commonly involve Pseudomonas or Acanthamoeba. Trauma usually involves fungal infection. In blepharitis, Staphylococcus is the most common cause of corneal ulceration, Donnenfeld said.
Common symptoms of infection include pain, decreased vision, photophobia, reflex tearing and lid swelling. Clinical signs include epithelial defect, separation, hypoxia and endophthalmitis. Neovascularization usually portends opportunistic infection or an inflammatory condition.
Treatment options include antibiotics such as cefazolin and tobramycin. Ciprofloxacin is optimal for treating Pseudomonas, while newer-generation fluoroquinolones such as besifloxacin are most effective in treating methicillin-resistant Staphylococcus aureus, Donnenfeld said.
Corticosteroids should be used only when an infection is under control, Donnenfeld said.
Corneal collagen cross-linking with riboflavin and ultraviolet A irradiation shows promise in treating infectious keratitis related to fungus, atypical bacterial infections and anaerobic strep, he said.
Disclosure: Donnenfeld is a consultant for Alcon, Abbott Medical Optics, Bausch + Lomb and LenSx.