Corneal scrape as risk of perforation and permanent central corneal scar.
must treat vigorously to avoid complications
Chong Chen Yee
Noor Munirah binti Awang Abu Bakar
• 23 years old lady, presented with 4 days history of redness of
the LE associated with pain. The RE BCVA is 6/6, LE BCVA 6/24.
• 23 years old, young
• 4 days
• Unilateral reduced vision LE
• With complaints of redness and pain
• What is bacterial keratitis?
• An infection of the cornea due to bacteria
• Causes pain, redness, reduced vision, light sensitivity, corneal
infiltrates, ulcerations, anterior chamber inflammation and
tearing or discharge from eye.
• A sight-threatening process
• Usually develops very quickly, and if left untreated, can cause
• The bacteria usually responsible:
• Staphylococcus Aureus (Infection)
• Pseudomonas Aeruginosa(CL wearer)
• Superficial keratitis:
• Affects uppermost layers of the cornea.
• Once healed, there is usually no scar on the cornea.
• Deep keratitis:
• Affects deeper corneal layers.
• Once healed, can be a scar left after healing which may or may
not affect vision, depending on where the scar is located.
Culture Media for Bacteria
Standard Media Common Isolates
Blood agar Anaerobic bacteria
(P. aeruginosa, S.
aureus, S. epidermidis,
Chocolate agar Anaerobic bacteria
(H. influenzae, N.
• Topical anesthetics
(minimal inhibitory effects
on organism recovery)
• Multiple samples from the
advancing borders of
representative area of the
ulcer are often required to
achieve maximal yield of
To confirm the presence of microorganism with sensitivity 55-79%.
To distinguish bacteria from fungi
Gram-positive retain the gentian violet-iodine complex and appear
Gram-negative lose the gentian violet-iodine complex by
decolorization with acid alcohol and appear pink when counterstained
Central or severe keratitis
Loading dose of fluoroquinolone eye drops every 5 to 15 mins for 1st
hourly day and night (48 hours)
hourly day and 2H night (3rd
2H day and 4H night (4th
4H day and night (6th
day, tapered to 6H and stopped when appropriate.
Cycloplegic agents use to decrease shynechia formation and decrease pain and
Use of topical corticosteroids with topical antibiotics. The corticosteroids used
to achieve control of inflammation.
• In this case, this young lady presented with 4 days painful
unilateral reduced vision LE associated with redness.
• The differential diagnosis for this case can uveitis, scleritis,
corneal infection and trauma.
• For corneal infection, among all the possible
microorganisms (Bacteria, virus, fungi, acanthamoeba etc),
only bacterial infection can cause acute ocular pain,
redness and reduced vision.
• The laboratory culture must be made in order to confirm the
• For other possible diagnosis, special investigations must be
• Bartolomei, A. 2014. Bacterial Keratitis.American Academy of
• Murillo-Lopez, F.H. 2014. Bacterial Keratitis. Medscape. From
• Kanski, J,J. 2003. Clinical Ophthalmology: A Systematic
• Jay H. Krachmer, MD, Mark J. Mannis MD, and Edward J.
Holland. Cornea (Fundamentals, diagnosis and management).
edition. 2011. Elsevier.