View source for Keratitis

__NOTOC__
{{DiseaseDisorder infobox |
  Name        = Keratitis |
  ICD10       = {{ICD10|H|16||h|15}} |
  ICD9        = {{ICD9|370}} |
  Image       = Clare-314.jpg |
  Caption     = An eye with non-ulcerative sterile keratitis. |
}}
{{Search infobox}}
{{CMG}}; {{AE}} {{MM}}, {{Faizan}}

==Overview==

'''Keratitis''' is a condition in which the [[eye]]'s [[cornea]] is inflamed.  Superficial keratitis involves the superficial layers of the [[cornea]]. After healing, this form of keratitis does not generally leave a scar.  Deep keratitis involves the deeper layers of the cornea, leaving a scar upon healing that impairs vision if on or near the visual axis.  Keratitis has multiple causes, one of which is an infection of a present or previous ''[[herpes simplex virus]]'' secondary to an upper respiratory infection, involving cold sores. Symptoms of keratitis include red eyes, sensitivity to light, and uncomfortable eyes.  In the later stages of more severe cases, there can be strong pain, loss of vision, blurry vision, and pus.  Microbial keratitis should be managed as bacterial keratitis until proven otherwise. [[Steroids]] are indicated in the management of keratitis to reduce inflammation that may damage the eye.

==Classification==
Superficial keratitis involves the superficial layers of the cornea. After healing, this form of keratitis does not generally leave a scar.

Deep keratitis involves deeper layers of the cornea, leaving a scar upon healing that impairs vision if on or near the visual axis.

==Pathophysiology==
Keratitis has multiple causes, one of which is an infection of a present or previous herpes simplex virus secondary to an upper respiratory infection, involving cold sores.

===Pathogens===
*Amoebic keratitis. Amoebic infection of the cornea is the most serious corneal infection, usually affecting soft [[contact lens]] wearers. It is usually caused by [[Acanthamoeba]]. On May 25, 2007, the CDC issued a health advisory due to increased risk of Acanthamoeba keratitis (AK)infection associated with use of Advanced Medical Optics (AMO) Complete Moisture Plus Multi-Purpose eye solution.  See [http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00260 CDC Advisory]
*[[Bacterial]] keratitis. Bacterial infection of the cornea can follow from an injury or from wearing contact lenses. The bacteriums usually involved are [[Staphylococcus aureus]] and for contact lens wearers [[Pseudomonas aeruginosa]].
*[[Fungal keratitis]] (cf. [[Fusarium]], causing recent incidences of keratitis through the possible [[vector (biology)|vector]] of Bausch & Lomb [[ReNu]] with MoistureLoc [[contact lens]] solution)
*[[Viral]] keratitis
:*[[Herpes simplex]] keratitis. Viral infection of the cornea is often caused by the [[herpes simplex]] virus which frequently leaves what is called a 'dendritic ulcer'. 
:*[[Herpes zoster]] keratitis

===Other===
*Exposure keratitis
*Photokeratitis - keratitis due to intense [[ultraviolet radiation]] exposure (e.g. [[snow blindness]] or welder's [[arc eye]].)
*[[Corneal ulcer|Ulcerative keratitis]]
*Contact lens acute red eye (CLARE) - a non-ulcerative sterile keratitis associated with colonization of Gram-negative bacteria on contact lenses
*Severe allergic response may lead to corneal inflammation and [[corneal ulcer|ulceration]] (i.e. [[vernal keratoconjunctivitis]]).[http://www.optometry.co.uk/files/0cd52f986c6c4d460c454802aa7cc5b3_schmid20010223.pdf]
*Drug Induced -  [[Afatinib]], [[Cyclopentolate]], [[Diclofenac (ophthalmic)]], [[Doxorubicin Hydrochloride]], [[Emedastine Difumarate]], [[Moxifloxacin ophthalmic]], [[Naphazoline]] , [[Nitisinone]], [[Panitumumab]], [[Pramipexole]]

==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

*[[Small pox]]

===Common Causes===

===Causes by Organ System===


{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Amaurosis fugax]], [[rheumatoid vasculitis]], [[vasculitis]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[water pollution|Contaminated water]], [[jellyfish|jellyfish stings]], [[phosgene oxime]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Atopic dermatitis]], [[Behcet disease]], [[epidermolysis bullosa]], [[erythema elevatum diutinum]], [[erythema multiforme]], [[ichthyosis]], [[keratitis-ichthyosis-deafness syndrome]], [[KID syndrome]], [[lepromatous leprosy]], [[phycomycosis]], [[pityriasis rubra pilaris]], [[rheumatoid vasculitis]], [[Stevens-Johnson syndrome]], [[systemic lupus erythematosus]], [[toxic epidermal necrolysis]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Aciclovir]], [[afatinib]], [[betaxolol (ophthalmic)]], [[bimatoprost]], [[brimonidine (ophthalmic)]], [[bromfenac]], [[cyclopentolate]], [[diclofenac (ophthalmic)]], [[dorzolamide]], [[doxorubicin hydrochloride]], [[Emedastine Difumarate|emedastine difumarate]], [[epinastine]], [[hydroxypropyl cellulose]], [[latanoprost]], [[moxifloxacin ophthalmic]], [[naphazoline]], [[natamycin]], [[nepafenac]], [[nitisinone]], [[non-steroidal anti-inflammatory drug|non-steroidal anti-inflammatory drug (topical)]], [[olopatadine]], [[panitumumab]], [[pramipexole]], [[scopolamine]], [[topical anesthetic]], [[travoprost]], [[trifluridine]], [[unoprostone]], [[vidarabine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Cogan syndrome]], [[ectrodactyly-ectodermal dysplasia-cleft syndrome]], [[keratitis-ichthyosis-deafness syndrome]], [[KID syndrome]], [[oculovestibuloauditory syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Graves' disease]], [[Graves ophthalmopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[water pollution|Contaminated water]], [[ultraviolet radiation]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Phycomycosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Epidermolysis bullosa]], [[facioscapulohumeral muscular dystrophy]], [[ichthyosis]], [[incontinentia pigmenti]], [[xeroderma pigmentosum]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[Henoch-Schönlein purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Radial keratotomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acanthamoeba]], [[adenovirus]], [[aspergillus fumigatus]], [[bacillus cereus]], [[balamuthia mandrillaris]], [[brucellosis]], [[candida]], [[canine herpesvirus]], [[congenital syphilis]], [[conjunctivitis]], [[corynebacterium diphtheriae]], [[crab louse]], [[dendritic ulcer]], [[enterobacteria]], [[enterovirus]], [[feline viral rhinotracheitis]], [[fungal keratitis]], [[fusarium]], [[haemophilus influenzae]], [[Herpes Simplex Keratitis|herpes simplex keratitis]], [[herpes simplex virus infection]], [[herpes zoster]], [[herpesviridae]], [[herpetic keratitis]], [[late congenital syphilitic oculopathy]], [[lepromatous leprosy]], [[listeria]], [[Lyme disease]], [[mansonella ozzardi]], [[measles]], [[microsporidiosis]], [[moraxella]], [[mycobacterium boenickei]], [[mycobacterium brisbanense]], [[mycobacterium houstonense]], [[mycobacterium neworleansense]], [[mycobacterium]], [[naegleria infection]], [[neisseria gonorrhea]], [[nocardiosis]], [[onchocerciasis]], [[orthopoxvirus]], [[parechovirus]], [[plesiomonas shigelloides]], [[pseudomonas aeruginosa]], [[psittacosis]], [[scedosporium apiospermum]], [[serratia marcescens]], [[shigella]], [[smallpox]], [[staphylococcus aureus]], [[staphylococcus epidermidis]], [[streptococcus pneumoniae]], [[syphilis]], [[trachoma]], [[vaccinia]], [[varicella-zoster virus]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[Acanthamoeba]]
*[[Aciclovir]]
*[[Adenovirus]]
*[[Afatinib]]
*[[Amaurosis fugax]] 
*[[Arc eye]]
*[[Aspergillus fumigatus]]
*[[Atopic dermatitis]]
*[[Bacillus cereus]]
*[[Balamuthia mandrillaris]]
*[[Behcet disease]]
*[[Betaxolol (ophthalmic)]]
*[[Bimatoprost]] 
*[[Brimonidine (ophthalmic)]] 
*[[Bromfenac]]
*[[Brucellosis]]
*[[Candida]]
*[[Canine herpesvirus]]
*[[Cogan syndrome]] 
*[[Confocal laser scanning microscopy]]
*[[Congenital syphilis]]
*[[Conjunctivitis]] 
*[[Connexin]]
*[[Contact lens]]
*[[Contact lens acute red eye]]
*[[water pollution|Contaminated water]]
*[[Corneal dystrophy]]
*[[Corneal transplantation]]
*[[Corneal ulcer]]
*[[Corynebacterium diphtheriae]]
*[[Crab louse]]
*[[Cyclopentolate]]
*[[Dendritic ulcer]]
*[[Diclofenac (ophthalmic)]]
*[[Dorzolamide]]
*[[Doxorubicin hydrochloride]]
*[[Dry eyes]]
*[[Ectrodactyly-ectodermal dysplasia-cleft syndrome]]
*[[Ectropion]]
*[[Emedastine Difumarate|Emedastine difumarate]]
*[[Enterobacteria]]
*[[Enterovirus]]
*[[Epidermolysis bullosa]]
*[[Epinastine]] 
*[[Erythema elevatum diutinum]]
*[[Erythema multiforme]]
*[[Exophthalmos]]
*[[Facial nerve paralysis]]
*[[Facioscapulohumeral muscular dystrophy]]
*[[Feline viral rhinotracheitis]]
*[[Fungal keratitis]]
*[[Fusarium]]
*[[Graves' disease]]
*[[Graves ophthalmopathy]]
*[[Haemophilus influenzae]]
*[[Henoch-Schönlein purpura]]
*[[Herpes Simplex Keratitis|Herpes simplex keratitis]]
*[[Herpes simplex virus infection]]
*[[Herpes zoster]]
*[[Herpesviridae]]
*[[Herpetic keratitis]]
*[[Hydroxypropyl cellulose]]
*[[Ichthyosis]]
*[[Immune reconstitution inflammatory syndrome]]
*[[Incontinentia pigmenti]]
*[[Injury]]
*[[jellyfish|Jellyfish stings]] 
*[[Keratitis-ichthyosis-deafness syndrome]]
*[[Keratoconjunctivitis]]
*[[Keratoconjunctivitis sicca]]
*[[KID syndrome]]
*[[Lagophthalmos]] 
*[[LASIK]] 
*[[Latanoprost]] 
*[[Late congenital syphilitic oculopathy]]
*[[Lepromatous leprosy]]
*[[Listeria]]
*[[Lyme disease]]
*[[Mansonella ozzardi]]
*[[Measles]] 
*[[Microsporidiosis]]
*[[Moraxella]]
*[[Moxifloxacin ophthalmic]]
*[[Mycobacterium]]
*[[Mycobacterium boenickei]] 
*[[Mycobacterium brisbanense]]
*[[Mycobacterium houstonense]]
*[[Mycobacterium neworleansense]]
*[[Naegleria infection]]
*[[Naphazoline]]
*[[Natamycin]]
*[[Neisseria gonorrhea]] 
*[[Nepafenac]]
*[[Nitisinone]]
*[[Nocardiosis]] 
*[[non-steroidal anti-inflammatory drug|Non-steroidal anti-inflammatory drug (topical)]]
*[[Ocular rosacea]]
*[[Oculotect]]
*[[Oculovestibuloauditory syndrome]]
*[[Olopatadine]] 
*[[Onchocerciasis]]
*[[Orthokeratology]]
*[[Orthopoxvirus]]
*[[Panitumumab]]
*[[Pannus]]
*[[Parechovirus]] 
*[[Phlyctenular keratoconjunctivitis]]
*[[Phosgene oxime]]
*[[Photokeratitis]]
*[[Phycomycosis]]
*[[Pityriasis rubra pilaris]]
*[[Plesiomonas shigelloides]] 
*[[Pramipexole]]
*[[Pseudomonas aeruginosa]] 
*[[Psittacosis]]
*[[Radial keratotomy]]
*[[Reactive arthritis]]
*[[Reiter's syndrome]]
*[[Relapsing polychondritis]]
*[[ReNu]]
*[[Rheumatoid arthritis]]
*[[Rheumatoid vasculitis]]
*[[Ribonucleotide reductase]]
*[[Scedosporium apiospermum]] 
*[[Scleritis]]
*[[Scopolamine]]
*[[Serratia marcescens]]
*[[Shigella]]
*[[Sicca syndrome]]
*[[Sjögren's syndrome]]
*[[Smallpox]] 
*[[Snow blindness]]
*[[Staphylococcus aureus]] 
*[[Staphylococcus epidermidis]]
*[[Stevens-Johnson syndrome]]
*[[Streptococcus pneumoniae]] 
*[[Superior limbic keratoconjunctivitis]]
*[[Syphilis]] 
*[[Systemic lupus erythematosus]]
*[[Thygeson's superficial punctate keratopathy]]
*[[Topical anesthetic]]
*[[Toxic epidermal necrolysis]]
*[[Trachoma]] 
*[[Travoprost]]
*[[Trifluridine]]
*[[Type II tyrosinemia]]
*[[Ultraviolet radiation]]
*[[Unoprostone]]
*[[Vaccinia]]
*[[Varicella-zoster virus]]
*[[Vasculitis]]
*[[Vernal keratoconjunctivitis]]
*[[Vidarabine]]
*[[Vitamin A deficiency]]
*[[Xeroderma pigmentosum]]
}}

==Symptoms==
The symptoms are often very similar to those of [[conjunctivitis]], an inflammation of the conjunctiva, and photophobia. The eye turns very red and there may be sensitivity to light, and the eye may feel uncomfortable. In the later stages of more severe cases, there can be strong pain, loss of vision/blurriness, and pus may form.

==Diagnosis==
Effective diagnosis is important in detecting this condition and subsequent treatment as keratitis is sometimes mistaken for an allergic [[conjunctivitis]].

==Treatment==
*Treatment depends on the cause of the keratitis.
*Microbial keratitis should be managed as bacterial keratitis until proven otherwise.
*Steroids are indicated in the management of keratitis to reduce inflammation that may damage the eye.
===Antimicrobial regimens===
====Bacterial Keratitis<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/bacterial-keratitis-ppp--2013#references/  | title == bacterial keratitis ppp 2013}}</ref>====
*'''1. Causative pathogens'''
:*Pseudomonas aeruginosa
:*Staphylococcus epidermidis
:*Staphylococcus aureus
:*Streptococcus pneumoniae
:*Serratia spp.
:*Hemophilus spp.
:*Moraxella spp.
:*Neisseria gonorrhea
:*Corynebacterium diphtheriae
:*Listeria spp.
:*Shigella spp.
:*Nocardia spp.
:*Mycobacterium spp.
*'''2. Empiric antimicrobial therapy'''
:*Preferred regimen (1): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
:*Preferred regimen (2): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
:*Preferred regimen (3): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks 
:*Preferred regimen (4): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*Preferred regimen (5): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q2h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14 {{or}} [[Gentamicin]] 1.5% ophthalmic ointment q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14)
:*Alternative regimen (1), unresponsive keratitis: [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*Alternative regimen (2): [[Erythromycin]] 0.5% ophthalmic ointment qhs for 1 week {{and}} ([[Amikacin]] 5% {{and}}/{{or}} [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
:* Note (1) : Subconjunctival antibiotics may be helpful where there is imminent scleral spread or perforation or in cases where adherence to the treatment regimen is questionable.
:* Note (2) : Systemic therapy is necessary for suspected gonococcal infection.
*'''3. Pathogen-directed antimicrobial therapy'''
:*'''3.1 Non-streptococcal gram-positive bacteria'''
::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks 
::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14 
:*'''3.2 Streptococcus pneumoniae'''
::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks 
::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Alternative regimen (unresponsive keratitis): [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*'''3.3 Nocardia spp.'''
::*Preferred regimen (1): [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (2): [[Erythromycin]] 0.5% ophthalmic ointment qhs for 1 week {{and}} ([[Amikacin]] 5% {{and}}/{{or}} [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
:*'''3.4 Gram-negative bacteria'''
::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks 
::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*'''3.5 Anaerobes'''
::*Preferred regimen (1): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::*Preferred regimen (2): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::*Preferred regimen (3): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks

===='''Fungal (mycotic) Keratitis'''<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>====
*'''1. Causative Pathogens.'''
:*Candida spp.
:*Fusarium spp.
:*Aspergillus spp.
:*Curvularia spp.
*'''2. Empiric antimicrobial therapy'''
:* Preferred regimen (1): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks
:* Preferred regimen (2): [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks
:* Preferred regimen (3): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks
:* Alternative regimen (1), unresponsive: [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
:*Alternative regimen (2), unresponsive: [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
*'''3. Special considerations'''
:*'''Immunocompromised status, spreading ulcer, impending perforation, true perforation'''
::*Preferred regimen (1): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks {{and}} ([[Ketoconazole]] IV 200-400 mg q12h for 2-3 weeks {{or}} [[Fluconazole]] IV 200 mg q12h for 2-3 weeks
::*Preferred regimen (2): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks {{and}} ([[Ketoconazole]] IV 200-400 mg q12h for 2-3 weeks {{or}} [[Fluconazole]] IV 200 mg q12h for 2-3 weeks
::*Note: Bacterial superinfection must be treated using [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14 {{or}} ([[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14)

===='''Protozoal Keratitis<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref><ref name="pmid19660733">{{cite journal| author=Dart JK, Saw VP, Kilvington S| title=Acanthamoeba keratitis: diagnosis and treatment update 2009. | journal=Am J Ophthalmol | year= 2009 | volume= 148 | issue= 4 | pages= 487-499.e2 | pmid=19660733 | doi=10.1016/j.ajo.2009.06.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19660733  }} </ref>'''====
*'''1. Causative pathogens'''
:*Acanthamoeba spp.
:*Microsporidia spp.
* '''2. Empiric antimicrobial therapy'''
:* Preferred regimen (1): [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Chlorhexidine]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}}/{{or}} ([[Propamidine]] 0.1% ophthalmic ointment q1h for 1-2 weeks {{or}} [[Hexamidine]] 0.1% ophthalmic ointment q1h for 2 days then q1h for another 3 days)
:* Preferred regimen (2): [[Propamidine]] 0.1% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks
:* Preferred regimen (4): [[Propamidine]] ophthalmic ointment q1h for 1-2 weeks {{and}} [[Chlorhexidine]] ophthalmic ointment q1h for 1-2 weeks
:* Preferred regimen (4): [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Hexamidine]] 0.1% ophthalmic ointment q1h for 2 days then q1h for another 3 days

===='''Viral Keratitis<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>'''====
*'''1. Causative pathogens'''
:*Herpes simplex virus (HSV)
*'''2. Empiric antimicrobial therapy'''
:*Preferred regimen (1): [[Acyclovir]] 3% ophthalmic ointment q5h for 2-3 weeks {{and}} [[Homatropine]] 2% ophthalmic solution bid for 2-3 weeks
:*Preferred regimen (2): [[Idoxuridine]] 0.1% ophthalmic solution q1h in daytime and 0.5% ophthalmic ointment qhs for 1 week then 0.1% ophthalmic solution q2h in daytime and 0.5% ophthalmic ointment qhs for 2-3 weeks {{and}} [[Homatropine]] 2% ophthalmic solution bid for 2-3 weeks

====Contraindicated medications====

{{MedCondContrAbs

|MedCond = Epithelial herpes simplex keratitis|Fluorometholone|Loteprednol|Rimexolone|Suprofen}}

==References==
{{Reflist}}

==Related Chapters==
*[[List of eye diseases and disorders]]
*[[List of systemic diseases with ocular manifestations]]
*[[Thygeson's superficial punctate keratopathy]]
*Chronic superficial keratitis, or pannus, for the disease in dogs

==External Links==
*[http://www.nei.nih.gov/health/cornealdisease/index.asp Facts About the Cornea and Corneal Disease] The National Eye Institute (NEI)
*[http://webeye.ophth.uiowa.edu/eyeforum/atlassearch1.htm?appSession=87915670818785&RecordID=1024&PageID=3&PrevPageID=2&cpipage=1&CPIsortType=&CPIorderBy= Filimentary keratitis]
<br>
{{Eye pathology}}

[[Category:Ophthalmology]]
[[Category:Optometry]]
[[Category:Inflammations]]
[[Category:Crowdiagnosis]]

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