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Clinical & Experimental Ophthalmology Jul 2022Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface... (Review)
Review
Globally, infectious keratitis is the fifth leading cause of blindness. The main predisposing factors include contact lens wear, ocular injury and ocular surface disease. Staphylococcus species, Pseudomonas aeruginosa, Fusarium species, Candida species and Acanthamoeba species are the most common causal organisms. Culture of corneal scrapes is the preferred initial test to identify the culprit organism. Polymerase chain reaction (PCR) tests and in vivo confocal microscopy can complement the diagnosis. Empiric therapy is typically commenced with fluoroquinolones, or fortified antibiotics for bacterial keratitis; topical natamycin for fungal keratitis; and polyhexamethylene biguanide or chlorhexidine for acanthamoeba keratitis. Herpes simplex keratitis is mainly diagnosed clinically; however, PCR can also be used to confirm the initial diagnosis and in atypical cases. Antivirals and topical corticosteroids are indicated depending on the corneal layer infected. Vision impairment, blindness and even loss of the eye can occur with a delay in diagnosis and inappropriate antimicrobial therapy.
Topics: Acanthamoeba; Acanthamoeba Keratitis; Blindness; Corneal Ulcer; Eye Infections, Fungal; Humans
PubMed: 35610943
DOI: 10.1111/ceo.14113 -
Deutsches Arzteblatt International Oct 2022Millions of people in Germany wear contact lenses every day. Deficient contact lens hygiene can lead to corneal infection. Contact lens-associated keratitis usually has... (Review)
Review
BACKGROUND
Millions of people in Germany wear contact lenses every day. Deficient contact lens hygiene can lead to corneal infection. Contact lens-associated keratitis usually has a highly acute presentation and can cause long-term visual loss.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on relevant metaanalyses, Cochrane reviews, and reports by national and international health care authorities.
RESULTS
23-94% of contact lens wearers report associated discomfort and eye problems. The annual incidence of contact lens-associated keratitis is 2-4/10 000. It is due to bacteria in 90% of cases, and much less commonly to acanthamoebae and fungi. The pathogens generally arrive with the contact lens on the surface of the eye and can penetrate into the corneal tissue because the tear film under the lens is not swept away from the ocular surface by the eyelids, and corneal epithelial changes are often present as well. Corneal infiltration that is diagnosed early is often self-limited, but advanced bacterial infection usually requires intense topical antibiotic treatment. Some severe infections can only be eradicated by emergency corneal transplantation; this is the case in 20-30 % of fungal and acanthamoebic infections.
CONCLUSION
The wearing of contact lenses, particularly soft ones, is associated with a risk of microbial keratitis if proper contact lens hygiene is not exercised. Contact lens-associated keratitis very rarely causes permanent damage to eyesight (0.6 cases per 10 000 contact lens wearers per year). The use of contact lenses always calls for meticulous care.
Topics: Humans; Corneal Ulcer; Keratitis; Contact Lenses; Cornea; Corneal Diseases
PubMed: 35912449
DOI: 10.3238/arztebl.m2022.0281 -
Survey of Ophthalmology 2022Fungal corneal ulcers are an uncommon, yet challenging, cause of vision loss. In the United States, geographic location appears to dictate not only the incidence of... (Review)
Review
Fungal corneal ulcers are an uncommon, yet challenging, cause of vision loss. In the United States, geographic location appears to dictate not only the incidence of fungal ulcers, but also the fungal genera most encountered. These patterns of infection can be linked to environmental factors and individual characteristics of fungal organisms. Successful management of fungal ulcers is dependent on an early diagnosis. New diagnostic modalities like confocal microscopy and polymerase chain reaction are being increasingly used to detect and identify infectious organisms. Several novel therapies, including crosslinking and light therapy, are currently being tested as alternatives to conventional antifungal medications. We explore the biology of Candida, Fusarium, and Aspergillus, the three most common genera of fungi causing corneal ulcers in the United States and discuss current treatment regimens for the management of fungal keratitis.
Topics: Antifungal Agents; Corneal Ulcer; Eye Infections, Fungal; Humans; Keratitis; Ulcer
PubMed: 34425126
DOI: 10.1016/j.survophthal.2021.08.002 -
BMJ Case Reports Apr 2019A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and...
A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew species. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.
Topics: Amphotericin B; Antifungal Agents; Corneal Edema; Corneal Ulcer; Eye Infections, Fungal; Female; Humans; Injections, Intraocular; Keratitis; Middle Aged; Mycoses; Paecilomyces; Recurrence; Surgical Flaps; Treatment Outcome; Visual Acuity
PubMed: 31023737
DOI: 10.1136/bcr-2019-229226 -
Australian Journal of General Practice Nov 2022Patients frequently present to general practitioners (GPs) with discomfort and a red eye due to corneal ulceration, defined as a defect in the corneal epithelium and...
BACKGROUND
Patients frequently present to general practitioners (GPs) with discomfort and a red eye due to corneal ulceration, defined as a defect in the corneal epithelium and underlying stroma. A myriad of conditions may lead to corneal ulcers, and prompt diagnosis and adequate management is needed to prevent visual morbidity.
OBJECTIVE
The aim of this article is to assist clinicians/GPs to 1) determine the likely cause of a corneal ulcer and 2) understand the management of corneal ulcers, including the timing of referral to an ophthalmologist.
DISCUSSION
Corneal ulcers are typically painful and reduce vision. A good understanding of the clinical presentation of corneal ulcers can aid diagnosis and guide treatment. Urgent referral of trauma and infectious keratitis to an ophthalmologist can prevent endophthalmitis and loss of vision and/or the eye. GPs can play an important part in timely referral, in some cases initiating oral antiviral treatment, and by educating patients on preventive measures, especially contact lens hygiene.
Topics: Humans; Corneal Ulcer; Ulcer; Keratitis; General Practice
PubMed: 36309998
DOI: 10.31128/AJGP-06-22-6453 -
The Veterinary Clinics of North... May 1990Ulcerative keratitis comprises an important proportion of presenting ocular complaints in small animals. Because of its high frequency, corneal ulceration may not... (Review)
Review
Ulcerative keratitis comprises an important proportion of presenting ocular complaints in small animals. Because of its high frequency, corneal ulceration may not routinely stimulate the clinical concern for rigorous diagnosis, attentive management, and aversion of potential complications that it merits. Only by maintaining an appreciation for the pathologic processes at work during corneal injury and repair can busy clinicians competently diagnose, successfully treat, and forestall the complications of corneal ulceration.
Topics: Animals; Cat Diseases; Cats; Corneal Ulcer; Dog Diseases; Dogs; Wound Healing
PubMed: 2194352
DOI: 10.1016/s0195-5616(90)50055-8 -
The Cochrane Database of Systematic... Jan 2014Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common... (Review)
Review
BACKGROUND
Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities.
OBJECTIVES
The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 June 2013.
SELECTION CRITERIA
We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered.
DATA COLLECTION AND ANALYSIS
Two authors screened the search results independently; we found no studies that met our inclusion criteria.
MAIN RESULTS
As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area.
AUTHORS' CONCLUSIONS
We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .
Topics: Corneal Ulcer; Humans
PubMed: 24452998
DOI: 10.1002/14651858.CD006131.pub3 -
Indian Journal of Ophthalmology Jan 2019A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial...
A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial keratoplasty followed by penetrating keratoplasty (PKP) presented with a 2.7 × 4.2 mm corneal ulcer, culture positive for Shewanella algae and Klebsiella oxytoca. A topical antibiotic regimen of gentamicin 14 mg/mL and vancomycin 50 mg/mL was administered according to culture sensitivities. There was concurrent use of loteprednol 0.5% (Lotemax Gel, Bausch and Lomb, Rochester, NY, USA) and later addition of erythromycin 0.5% ointment. The corneal ulcer improved with antibiotic therapy but was complicated by poor patient follow-up. Descemetocele formation prompted PKP in the right eye. The graft was successful and visual acuity improved from a low of light perception to maximum of 20/200 Snellen.
Topics: Aged; Anti-Bacterial Agents; Cornea; Corneal Ulcer; Eye Infections, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Shewanella
PubMed: 30574928
DOI: 10.4103/ijo.IJO_617_18 -
Indian Journal of Ophthalmology May 2022Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or... (Review)
Review
Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.
Topics: Anti-Infective Agents; Corneal Perforation; Corneal Ulcer; Eye; Humans; Keratitis
PubMed: 35502013
DOI: 10.4103/ijo.IJO_2273_21 -
Revue Medicale de Liege Oct 2021Peripheral ulcerative keratitis (PUK) is a disorder of the juxtalimbal cornea characterised by a crescent-shape destructive inflammation of corneal stroma. PUK can be...
Peripheral ulcerative keratitis (PUK) is a disorder of the juxtalimbal cornea characterised by a crescent-shape destructive inflammation of corneal stroma. PUK can be associated with various ocular and systemic infectious and non infectious diseases. Different systemic autoimmune vasculitis that can prove potentially fatal may present as PUK. Potentially serious ocular complications of PUK exist. A careful clinical evaluation helps in timely diagnosis and prevention of complications.
Topics: Cornea; Corneal Ulcer; Humans
PubMed: 34632744
DOI: No ID Found