. Prenatal: Maternal Age: 30 Maternal Blood Type: B+ Age of Gestation: RHV Smoking Alcohol intake: PNC: MD: Illness/Injuries/Medication/Chemical Exposure/Exposure to X-ray/Etc...: 2. Natal Place of Delivery:n p Assisted by:

1. Bacterial keratitis
Krithik Mahesh
Hemnath Saravanan

2. Bacterial keratitis
 Keratitis - Inflammation of the cornea.
 Microbial keratitis or infectious corneal ulcer is due to the
proliferation of microorganisms (including bacteria, fungi,
viruses, and parasites) and associated inflammation and
tissue destruction within the corneal tissue .
 Bacterial keratitis - most common cause of suppurative
corneal ulceration (disruption of the epithelial layer with
involvement of the corneal stroma).

3. BACTERIAL KERATITIS
• Needs urgent medical attention
• Prompt diagnosis
• Initiation of appropriate antibiotic
• Limit amount of tissue destruction
• Improve patient’s visual prognosis

4. Risk Factors for bacterial keratits
EXTRINSIC FACTORS
• Contact lens wear
• Trauma
• Previous ocular and eyelid surgery
• Loose corneal sutures
• Medication-related factors
• Immunosuppression

5. Risk Factors for bacterial keratits
Corneal surface disease
•Tear-film deficiencies
•Abnormalities of the eyelid anatomy and function
•Misdirection of eyelashes
•Adjacent infection/inflammation- Blepharitis

6. Risk Factors for bacterial keratits
• Corneal epithelial abnormalities
• Neurotrophic keratopathy
• Recurrent corneal erosion
• Corneal abrasion or epithelial defect
• Viral keratitis
• Corneal epithelial edema

7. Risk Factors for bacterial keratits
Systemic conditions
• Diabetes
• Systemic infections
• Collagen vascular diseases
• Immuno suppressive drug
• Chronic alcholism
• Extensive body burns
• Drug addiction
• AIDS

8. Common bacterial pathogens that cause keratitis
Bacterium Typical characteristics of infection
Staphylococcus aureus(most common)
Staphylococcus
epidermidis
Infection progresses slowly with little pain
Streptococcus
pneumoniae
Typical serpiginous corneal ulcer: cornea is
rapidly
Perforated with early intraocular
involvement;very painful.
Pseudomonas aeruginosa ( most common
organism in soft contact lens wearers)
Bluish green mucoid exudate,occasionally with
a ring shaped corneal abscess.Progressionis
rapid with a tendency to ward melting of the
cornea over a wide area;painful.

9. Clinical features of Gram positive and Gram negative
Feature Gram positive Gram negative
Appearance Mild to dense infiltrate Dense infiltrate necrosis
Borders Distinct infiltrate borders Indistinct borders
Surrounding cornea
Hypopyon
Generally clear
Less common
Often hazy
More common

10. 1. White stromal infiltrate associated
with an overlying epithelial defect and
secondary anterior uveitis .
SIGNS

11. 2. Enlargement of stromal infiltration
associated with stromal oedema

12. 3.Severe infiltration and hypopyon
formation

13. 4.Progressive ulceration and enlargement
of hypopyon

14. 5.Corneal perforation and endophthalmitis
in neglected cases

15. Differential Diagnosis
Nonbacterial corneal pathogens
• Fungi
• Parasites
• Viruses
Noninfectious corneal infiltrations
• May be associated with contact lens wear.
• Systemic dis. eg, collagen vascular and rheumatoid dis.
• Dermatologic disorders and allergic conditions.
• Corneal trauma and foreigon bodies.

16. MANIFESTATIONS AND DIAGNOSIS APPRAOCH
History
• Ocular symptoms: pain, redness, discharge, blurred vision,
photophobia, coloured haloes, blepharospsm..
• Review of prior ocular history
• Review of other medical problems.
• Current ocular medications.
• Medication allergies.
Examination
• Visual Acuity
• External Examination
• Slit-Lamp Biomicroscopy.

17. Diagnostic Tests
Cultures and Smears indicated in:
• Cases with acorneal infiltrate that is large and extends deep to the
middle of the stroma, that is chronic in nature or unresponsive to
broad spectrum A.B therapy.
• Features suggestive of fungal, amœbic,or mycobacteria.
• Smears may be helpful in cases of severe ulcerative keratitis or in
cases with clinical features suggestive of fungal, amoebic,or
mycobacterial infection.
Corneal Biopsy indicated in:
• Lack of response to treatment or if cultures have been negative on
more than one occasion and the clinical picture continues to suggest
strongly an infectious process.

18. TREATMENT
• 1- Antibiotics: Initial empiric
Topical
• Are the preferred method of treatment in most cases.
• Using a fluoroquinolone is effective.
• Combination fortified-antibiotic therapy is an alternative to consider for severe
infection. Tobramycin (14 mg/mL) 1 drop every hour alternating with fortified
cefazolin (50 mg/mL) or vancomycin (50mg/mL) 1 drop every hour.
• For severe cases, a loading dose every 5 to 15
• minutes for the first hour, followed by applications every 15 min to 1 hour
around the clock.
• For less severe cases, a regimen with less frequent dosing is appropriate.

19. 1- Antibiotics: Initial empiric
Subconjunctival
• Given when there is imminent scleral spread or perforation
• One injection per day for 5 days.
• helpful where there is imminent scleral spread or
• perforation
Systemic
• Used when infectious has extended to adjacent tissues or when
there is impending or frank perforation.
• Gonococcal keratitis

20. TREATMENT
2- Modification of Therapy
• Regimen should be modified if the patient is not responding
• to initial therapy or ulcer progress .according to culture and
sensitivity.
3- Topical Cycloplegics
4- Corticosteroid Therapy
• There is no conclusive scientific evidence that shows that steroids
alter clinical outcome.
• Infiltrate compromises the visual axis. To be on 2-3 days of
treatment.
5- Follow-up Evaluation

21. Prevention and Early Detection
• Screening of patient with high risk factors
• Education on use of extended wear contact lens
• Protective eye wear for work and sports
• Treatment of ocular surface disease