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Ocular Infections pp 73–93Cite as

Infectious Keratitis

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Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Microbial keratitis is a common cause of ocular morbidity and loss of vision. The causes of infectious keratitis include viruses, bacteria, fungi, and parasites. The disease varies from mild superficial keratitis to deep corneal ulceration with descemetocele and corneal perforation. Microbial keratitis is vision threatening. Therefore, early diagnosis, microbiological identification, and prompt management are mandatory. Prognosis of infectious keratitis depends on the causative agent, predisposing factors, ocular surface integrity, and duration of the disease. Most cases of microbial keratitis are treated with topical antibiotics and addressing the ocular surface abnormalities. The therapy of bacterial, fungal, and parasitic infections requires compounding of topical antibiotics. Infectious keratitis requires urgent management.

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References

  1. Cokingtin CD, Hyndiuk RA. Bacterial keratitis. In: Tabbara KF, Hyndiuk RA, editors. Infections of the eye. 2nd ed. Boston: Little, Brown and Company; 1996. p. 326.

    Google Scholar 

  2. Leibowitz HM. Clinical evaluation of ciprofloxacin 0.3 % ophthalmic solution for treatment of bacterial keratitis. Am J Ophthalmol. 1991;1123(4 Suppl):34S–47.

    Google Scholar 

  3. Yanoff M, Duker J. Ophthalmology. In: James J, editor. Augsburger. 3rd ed. Edinburgh: Mosby Elsevier; 2009. p. 274–88.

    Google Scholar 

  4. Lucht E, Brytting M, Bjerregaard L, Julander I, Linde A. Shedding of cytomegalovirus and herpesviruses 6, 7, and 8 in saliva of human immunodeficiency virus type 1-infected patients and healthy controls. Clin Infect Dis. 1998;27(1):137–41.

    Article  CAS  PubMed  Google Scholar 

  5. Hanshaw JB. Herpes virus hominis infections in the fetus and the newborn. Am J Dis Child. 1973;126:546.

    CAS  PubMed  Google Scholar 

  6. Cook SD, Hill JH. Herpes simplex virus. Molecular biology and the possibility of corneal latency. Surv Ophthalmol. 1991;36(2):140–8.

    Article  CAS  PubMed  Google Scholar 

  7. Saini JS, Agarwal R. Clinical pattern of recurrent herpes simplex keratitis. Indian J Ophthalmol. 1999;47(11):11–4.

    CAS  PubMed  Google Scholar 

  8. Hyndiuk RA, Glasser DB. Herpes simplex keratitis. In: Hyndiuk RA, Tabbara KF, editors. Infections of the eye. 2nd ed. Boston: Little, Brown and Company; 1996. p. 370–2.

    Google Scholar 

  9. Tabbara KF. Treatment of herpetic keratitis. Ophthalmology. 2005;112(9):1640.

    Article  PubMed  Google Scholar 

  10. Wilhelmus KR. The treatment of herpes simplex virus epithelial keratitis. Trans Am Ophthalmol Soc. 2000;98:505–32.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Knickelbein JE, Hendricks RL, Charukamnoetkanok P. Management of herpes simplex virus stromal keratitis: an evidence-based review. Surv Ophthalmol. 2009;54(2):226–34. doi:10.1016/j.survophthal.2008.12.004.

    Article  PubMed  Google Scholar 

  12. Wilhelmus KF, Gee L, Houck WW, Kurimij N, Jones DB, et al. Herpetic Eye Disease Study. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Ophthalmology. 1994;101(12):1883–95.

    Article  CAS  PubMed  Google Scholar 

  13. Porter SM, Patterson A, Kho P. A comparison of local and systemic acyclovir in the management of herpetic disciform keratitis. Br J Ophthalmol. 1990;74(5):283–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Garcia DD, Farjo Q, Musch DC, Sugar A. Effect of prophylactic oral acyclovir after penetrating keratoplasty for herpes simplex keratitis. Cornea. 2007;26(8):930–4.

    Article  PubMed  Google Scholar 

  15. Tabbara KF, Al Balushi N. Topical ganciclovir in the treatment of acute herpetic keratitis. Clin Ophthalmol. 2010;4:905–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Sozen E, Avundeek AM, Akyd N. Comparison of efficacy of oral valacyclovir and topical acyclovir in the treatment of herpes simplex keratitis. A randomized clinical trial. Chemotherapy. 2006;52:29–31.

    Article  CAS  PubMed  Google Scholar 

  17. Borit J, Pentelei-Molnar J, Lazaro R. Varicella dendritic keratitis. Invest Ophthalmol Vis Sci. 1974;13(10):764–70.

    Google Scholar 

  18. Wilhelmus KR, Hamill MB, Jones DB. Varicella disciform stromal keratitis. Am J Ophthalmol. 1991;111(5):575–80.

    Article  CAS  PubMed  Google Scholar 

  19. Kennedy PG. Varicella-zoster virus latency in human ganglia. Rev Med Virol. 2002;12(5):327–34.

    Article  CAS  PubMed  Google Scholar 

  20. Pavan-Langston D. Herpes zoster ophthalmicus. Neurology. 1995;45(12 Suppl 8):S50–1.

    Article  CAS  PubMed  Google Scholar 

  21. Hutchinson J. Clinical report on herpes zoster frontalis ophthalmicus. Ophthal Hosp Rep. 1864;3(72):865–6; J R Lond Ophthal Hosp Lond. 1865;5:191.

    Google Scholar 

  22. Liesegang TG. Corneal complications from herpes zoster ophthalmicus. Ophthalmology. 1985;42(3):316–24.

    Article  Google Scholar 

  23. Noseri A, Good WV, Cunningham T. Herpes zoster virus sclerokeratitis and uveitis in a child following varicella vaccination. Am J Ophthalmol. 2003;135(3):415–7.

    Article  Google Scholar 

  24. Dworkin RH, Johnson RW. Recommendation for the management of herpes zoster. Clin Infect Dis. 2007;44:S1–26.

    Article  CAS  PubMed  Google Scholar 

  25. Wang AG, Liu ZH, Hsu WM, Lee AF, Yen MY. Optic neuritis in herpes zoster ophthalmicus. Jpn J Ophthalmol. 2000;44(5):550–4.

    Article  CAS  PubMed  Google Scholar 

  26. Lambiase A, Paolo R, Luigi A, Bionini S. Management of neurotrophic keratopathy. Curr Opin Ophthalmol. 1999;10(4):270–6.

    Article  CAS  PubMed  Google Scholar 

  27. Khokhar S, Natung T, Sony P, Sharma N, Agarwal N, Vajpayee RB. Amniotic membrane transplantation as refractory neutrophic corneal ulcers. Cornea. 2005;24(6):654–60.

    Article  PubMed  Google Scholar 

  28. Menke JJ, Heins JR. Treatment of postherpetic neuralgia. J Am Pharm Assoc (Wash). 1996;39(2):217–21.

    Google Scholar 

  29. Nalamanchu S, Morley-Foster P. Diagnosing and managing postherpetic neuralgia. Drugs Aging. 2012;29(11):863–9.

    Article  Google Scholar 

  30. Oxman MN, et al., Shingles prevention study group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271–84. doi: 10.1056/NEJMoa051016

    Article  CAS  PubMed  Google Scholar 

  31. Matoba AY. Ocular disease associated with Epstein-Barr virus infection. Surv Ophthalmol. 1990;35(2):145–50.

    Article  CAS  PubMed  Google Scholar 

  32. Ongkosuwito JV, Ongkosuwito JV, Allegonda van der L, Bruinnenberg M, Wienssen van dorn M, Feron EJC, Bhyong C, de Keizer R, Klok A, Kijlstra A. Increased presence of EBV DNA in ocular fluid samples from HIV negative immunocompromised patients with uveitis. Br J Ophthalmol. 1998;82:245–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834-40. doi: 10.1016/j.ajo.2007.12.015. Epub 2008 Feb 6.

    Article  PubMed  Google Scholar 

  34. Mietz H, Aisenbrey S, Bartz-Schmidt KU, Bamborschke S, Krieglstein GK. Ganciclovir for the treatment of anterior uveitis. Graefes Arch Clin Exp Ophthalmol. 2000;238(11):905–9.

    Article  CAS  PubMed  Google Scholar 

  35. Gupta S, Vemulakonda GA, Suhler EB, Yeh S, Albini TA, Mandelcorn E, Flaxel CJ. Cytomegalovirus retinitis in the absence of AIDS. Can J Ophthalmol. 2013;48(2):126–9.

    Article  PubMed  Google Scholar 

  36. Kappel PJ, Charonis AC, Holland GN, Narayanan R, Kulkarni AD, Yu F, Boyer DS. Outcomes associated with ganciclovir implants in patient with AIDS-related cytomegalovirus retinitis. Ophthalmology. 2006;113(4):683.e1–8.

    Article  Google Scholar 

  37. Khairallah SH, Byrne KA, Tabbara KF. Fungal keratitis in Saudi Arabia. Doc Ophthalmol. 1992;79(3):269–76.

    Article  CAS  PubMed  Google Scholar 

  38. Tanure MG, Cohen EJ, Sudesh S, Rapuano CG, Laibson PR. Spectrum of Fungal Keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea. 2000;19(3):307–12.

    Article  CAS  PubMed  Google Scholar 

  39. Tilak R, Singh A, Maurya OP, Chandra A, Tilak V, Gulati AK. Mycotic keratitis in India: a five year retrospective study. J Infect Dev Ctries. 2010;4(3):171–4.

    Article  PubMed  Google Scholar 

  40. Thomas PA, Myatt AK. Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi. Br J Ophthalmol. 2005;89:1554–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Vaddavalli PK, Garg P, Sharma S, Sangwan VS, Rao GN, Thomas R. Role of confocal microscopy in the diagnosis of fungal and acanthamoeba keratitis. Ophthalmology. 2011;118(1):29–35. doi:10.1016/j.ophtha.2010.05.018.

    Article  PubMed  Google Scholar 

  42. Lalitha P, Prajna NV, Kabra A, Mahadevan K, Srinivasan M. Risk factors for treatment outcome in fungal keratitis. Ophthalmology. 2006;113(4):526–30.

    Article  PubMed  Google Scholar 

  43. Mellado F, Rojas T, Cumsille C. Fungal keratitis: review of diagnosis and treatment. Arq Bras Oftalmol. 2013;76(1):52–6. Article In Spanish.

    Article  PubMed  Google Scholar 

  44. Moraud K, Bartolleti AC, Bochot A, Barratt G, Brandely ML, Chost F. Liposomal amphotericin B eyedrops to treat fungal keratitis: physiochemical and formulation stability. Int J Pharm. 2007;344(1–2):150–3.

    Google Scholar 

  45. Behens-Baumann W, Kringe B, Ruchel B. Topical fluconazole for experimental Candida keratitis in rabbits. Br J Ophthalmol. 1990;74:40–2.

    Article  Google Scholar 

  46. Isipradit S. Efficacy of fluconazole subconjunctival injection as adjunctive therapy for severe recalcitrant fungal corneal ulcer. J Med Assoc Thai. 2008;91(3):309–15.

    PubMed  Google Scholar 

  47. Troke P, Obenga G, Gaujoux T, Goldschmidt P, Bienvenu AL, Cornet M, Grenouillet F, Pons D, Ranque S, Sitbon K, Chaumeil C, Borderie V, Lortholary O. The efficacy of voriconazole in 24 ocular fusarium infections. Infection. 2013;41(1):15–20.

    Article  CAS  PubMed  Google Scholar 

  48. Sponsel W, Chan N, Dang D, Paris G, Graybill J, Najvar LK, Zhou L, Lam KW, Glickman R, Scribbick P. Topical voriconazole as a novel treatment for fungal keratitis. Antimicrob Agents Chemother. 2006;50(1):262–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Sharma N, Agarwal P, Sinha R, Titiyal JS, Velpandian T, Vajpayee RB. Evaluation of intrastromal voriconazole injection in recalcitrant deep fungal keratitis: case series. Br J Ophthalmol. 2011;95(12):1735–7.

    Article  PubMed  Google Scholar 

  50. Xie L, Zgai H, Shi W. Penetrating keratoplasty for corneal perforations in fungal keratitis. Cornea. 2007;26(2):158–62.

    Article  PubMed  Google Scholar 

  51. Galperin G, Berra M, Tau J, Boscaro G, Zarate J, Berra A. Treatment of fungal keratitis from Fusarium infection by corneal cross-linking. Cornea. 2012;31(2):176–80.

    Article  PubMed  Google Scholar 

  52. Thebpatiphat N, Hammersmith KM, Rocha FN, Rapuano CJ, Ayres BD, Laibson PR, Eagle Jr RC, Cohen EJ. Acanthamoeba keratitis: a parasite on the rise. Cornea. 2007;26(6):701–6.

    Article  PubMed  Google Scholar 

  53. Radford CF, Bacon AS, Dart JK, Minassian DC. Risk factors for Acanthamoeba keratitis in contact lens users: a case study. BMJ. 1995;310(6994):1567–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Lindsay RG, Watters G, Johnson R, Ormonde SE, Snibson GR. Acanthamoeba keratitis and contact lens wear. Clin Exp Optom. 2007;90(5):351–60.

    Article  PubMed  Google Scholar 

  55. Sun X, Zhang Y, Li R, Wang Z, Luo S, Gao M, Deng S, Chen W, Jin X. Acanthamoeba keratitis: clinical characteristics and management. Ophthalmology. 2006;113(3):412–6.

    Article  PubMed  Google Scholar 

  56. Matin A, Jung S-Y. Interaction of Escherichia coli K1 and K5 with Acanthamoeba castellanii trophozoites and cysts. Korean J Parasitol. 2011;49(4):349–56.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Epstein RJ, Wilson LA, Visvesvara GS, Plourde Jr EG. Rapid diagnosis of Acanthamoeba keratitis from corneal scrapings using indirect fluorescent antibody staining. Arch Ophthalmol. 1986;104(9):1318–21.

    Article  CAS  PubMed  Google Scholar 

  58. Wilhelmus KR, Osato MS, Font RL, Robinson NM, Jones DB. Rapid diagnosis of Acanthamoeba keratitis using calcofluor white. Arch Ophthalmol. 1986;104(9):1309–12.

    Article  CAS  PubMed  Google Scholar 

  59. Parmar DN, Awwad ST, Petroll WM, Bowman RW, McCulley JP, Cavanagh HD. Tandem scanning confocal corneal microscopy in the diagnosis of suspected acanthamoeba keratitis. Ophthalmology. 2006;113(4):538–47.

    Article  PubMed  Google Scholar 

  60. Sharma S, Garg P, Rao GN. Patients characteristics, diagnosis and treatment of non-contact lens related Acanthamoeba keratitis. Br J Ophthalmol. 2000;84(10):1103–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Bang S, Edell E, Eghrari AO, Gottsch JD. Treatment with voriconazole in 3 eyes with resistant Acanthamoeba keratitis. Am J Ophthalmol. 2010;149(1):66–9.

    Article  CAS  PubMed  Google Scholar 

  62. Shadduck JA, Greeley E. Microsporidia and human infections. Clin Microbiol Rev. 1989;2(2):158–65.

    CAS  PubMed Central  PubMed  Google Scholar 

  63. Das S, Sharma S, Sahu SK, Nayak SS, Kar S. New microbial spectrum of epidemic keratoconjunctivitis: clinical and laboratory aspects of an outbreak. Br J Ophthalmol. 2008;92(6):861–2. No abstract available.

    CAS  PubMed  Google Scholar 

  64. Joseph J, Vemuganti GK, Sharma S. Microsporidia: emerging ocular pathogens. Indian J Med Microbiol. 2005;23(2):80–91.

    Article  CAS  PubMed  Google Scholar 

  65. Cali A, Meisler DM, Lowder CY, Lembach R, Ayers L, Takvorian PM, Rutherford I, Longworth DL, McMahon J, Bryan RT. Corneal microsporidioses: characterization and identification. J Protozool. 1991;38(6):215–7.

    Google Scholar 

  66. Lowder CY, Meisler DM, McMahon JT, Longworth DL, Rutherford I. Microsporidia infection of the cornea in a man seropositive for human immunodeficiency virus. Am J Ophthalmol. 1990;109(2):242–4.

    Article  CAS  PubMed  Google Scholar 

  67. Rosberger DF, Serdarevic ON, Erlandson RA, Bryan RT, Schwartz DA, Visvesvara GS, Keenan PC. Successful treatment of microsporidial keratoconjunctivitis with topical fumagillin in a patient with AIDS. Cornea. 1993;12(3):261–5.

    Article  CAS  PubMed  Google Scholar 

  68. Khandelwal SS, Woodward MA, Hall T, Grossniklaus HE, Stulting RD. Treatment of microsporidia keratitis with topical voriconazole monotherapy. Arch Ophthalmol. 2011;129(4):509–10. doi:10.1001/archophthalmol.2011.54.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, Alvar J, Boelaert M. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5(11):873–82.

    Article  CAS  PubMed  Google Scholar 

  70. Montero JA, Ruiz-Moreno JM, Sanchis E. Intraretinal hemorrhage associated with leishmaniasis. Ophthalmic Surg Lasers Imaging. 2003;34(3):212–4.

    PubMed  Google Scholar 

  71. Thakur CP, Singh RK, Hassan SM, Kumar R, Narain S, Kumar A. Amphotericin B deoxycholate treatment of visceral leishmaniasis with newer modes of administration and precautions: a study of 938 cases. Trans R Soc Trop Med Hyg. 1999;93(3):319–23.

    Article  CAS  PubMed  Google Scholar 

  72. WHO Library Cataloguing-in-Publication Data. Global Initiative for the Elimination of Avoidable Blindness: action plan 2006–2011. I.World Health Organization. ISBN 978 92 4 159588 9 (NLM classification: WW 140).

    Google Scholar 

  73. Kayembe DL, Kasonga DL, Kayembe PK, Mwanza JC, Boussinesq M. Profile of eye lesions and vision loss: a cross-sectional study in Lusambo, a forest-Savanna area hyperendemic for Onchocerciasis in the Democratic Republic of Congo. Trop Med Int Health. 2003;8(1):88–9.

    Article  Google Scholar 

  74. Basáñez MG, Pion SD, Boakes E, Filipe JA, Churcher TS, Boussinesq M. Effect of single-dose ivermectin on Onchocerca volvulus: a systematic review and met-analysis. Lancet Infect Dis. 2008;8(5):310–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia

    Khalid F. Tabbara MD, ABO, FRCOphth & Charbel T. Bou Chacra MD, FRCS (Glasg)

  2. Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Khalid F. Tabbara MD, ABO, FRCOphth

  3. The Wilmer Ophthalmological Institute of The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Khalid F. Tabbara MD, ABO, FRCOphth

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  1. Khalid F. Tabbara MD, ABO, FRCOphth
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  2. Charbel T. Bou Chacra MD, FRCS (Glasg)
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Correspondence to Khalid F. Tabbara MD, ABO, FRCOphth .

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Editors and Affiliations

  1. Department of Ophthalmology, The Eye Center, Riyadh, Saudi Arabia

    Khalid F. Tabbara

  2. Department of Ophthalmology, King Abdulaziz University Hospital, Riyadh, Saudi Arabia

    Ahmed M. Abu El-Asrar

  3. Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia

    Moncef Khairallah

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Tabbara, K.F., Chacra, C.T.B. (2014). Infectious Keratitis. In: Tabbara, K., El-Asrar, A., Khairallah, M. (eds) Ocular Infections. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43981-4_7

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