RISK FACTORS:
β’ Any abrasive injury
β’ Contact lenses (especially soft lenses)
β’ Chronic topical steroid use
GENERAL MEASURES :
β’ Aggressive topical antibiotic treatment directed toward the causative agent should be instituted immediately
while culture studies are pending
β’ Supplemental topical cycloplegia reduces the inflammation and aids in patient comfort
β’ Bandaging the eye should be avoided and topical steroids should never be used. Daily evaluation is necessary and prompt consultation with an ophthalmologist or corneal specialist is advised.
ACTIVITY: Reduced, until vision returns to normal and healing is complete
DRUG(S) OF CHOICE :
β’ Sulfacetamide 10% suspension (bacteriostatic) is only good for low grade conjunctival infections
β’ Topical gentamicin and tobramycin are effective against Pseudomonas, Enterobacter, Klebsiella, and aerobic gram negative organisms, while cephalosporins (e.g., cefazolin 50 mg/mL) may be effective against many gram negative organisms. The combination aminoglycoside and cephalosporin may be the most appropriate initial therapy.
β’ Topical quinolones, e.g., ciprofloxacin (Ciloxan) 0.3%, ofloxacin (Ocufl ox) 0.3%, gatifloxacin (Zymar), levofl
oxacin (Quixin), moxifloxacin (Vigamox). These may be treatment of choice for Pseudomonas infections.
β’ Ointments, e.g. bacitracin, erythromycin, polymyxin B/bacitracin combos (Neosporin)
β’ Fungal keratitis needs to be treated with parenteral amphotericin B for candida and aspergillus; clotrimazole,
miconazole, econazole, and ketoconazole may also be required
PATIENT MONITORING : The patient should be monitored at least daily until healed
PREVENTION/AVOIDANCE : Avoid corneal abrasion or injury and improper contact lens handling
POSSIBLE COMPLICATIONS: Scarring of the cornea and loss of vision
EXPECTED COURSE/PROGNOSIS :
β’ Corneal ulcerations should improve daily and heal with appropriate therapy
β’ If healing does not occur or the ulcer extends, then consideration should be given to an alternative diagnosis and treatment
PATIENT EDUCATION : Prevention of abrasions and proper handling of contact lenses can prevent recurrence of corneal ulcers