Keratitis: Difference between revisions

Latest revision as of 21:33, 10 January 2020

Template:DiseaseDisorder infobox Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2], Ogheneochuko Ajari, MB.BS, MS [3], Faizan Sheraz, M.D. [4]

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 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 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.)
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 ulceration (i.e. vernal keratoconjunctivitis).[5]
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

Cardiovascular	Amaurosis fugax, rheumatoid vasculitis, vasculitis
Chemical/Poisoning	Contaminated water, jellyfish stings, phosgene oxime
Dental	No underlying causes
Dermatologic	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
Drug Side Effect	Aciclovir, afatinib, betaxolol (ophthalmic), bimatoprost, brimonidine (ophthalmic), bromfenac, cyclopentolate, diclofenac (ophthalmic), dorzolamide, doxorubicin hydrochloride, emedastine difumarate, epinastine, hydroxypropyl cellulose, latanoprost, moxifloxacin ophthalmic, naphazoline, natamycin, nepafenac, nitisinone, non-steroidal anti-inflammatory drug (topical), olopatadine, panitumumab, pramipexole, scopolamine, topical anesthetic, travoprost, trifluridine, unoprostone, vidarabine
Ear Nose Throat	Cogan syndrome, ectrodactyly-ectodermal dysplasia-cleft syndrome, keratitis-ichthyosis-deafness syndrome, KID syndrome, oculovestibuloauditory syndrome
Endocrine	Graves' disease, Graves ophthalmopathy
Environmental	Contaminated water, ultraviolet radiation
Gastroenterologic	Phycomycosis
Genetic	Epidermolysis bullosa, facioscapulohumeral muscular dystrophy, ichthyosis, incontinentia pigmenti, xeroderma pigmentosum
Hematologic	Henoch-Schönlein purpura
Iatrogenic	Radial keratotomy
Infectious Disease	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 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
Musculoskeletal/Orthopedic	Facioscapulohumeral muscular dystrophy
Neurologic	Amaurosis fugax, facial nerve paralysis
Nutritional/Metabolic	Ribonucleotide reductase, type II tyrosinemia, vitamin A deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	Amaurosis fugax, arc eye, Cogan syndrome, confocal laser scanning microscopy, conjunctivitis, contact lens acute red eye, contact lens, corneal dystrophy, corneal transplantation, corneal ulcer, dry eyes, ectropion, exophthalmos, fungal keratitis, Graves ophthalmopathy, keratitis-ichthyosis-deafness syndrome, keratoconjunctivitis sicca, keratoconjunctivitis, KID syndrome, lagophthalmos, LASIK, late congenital syphilitic oculopathy, ocular rosacea, oculotect, oculovestibuloauditory syndrome, orthokeratology, pannus, phlyctenular keratoconjunctivitis, photokeratitis, radial keratotomy, ReNu, scleritis, snow blindness, superior limbic keratoconjunctivitis, Thygeson's superficial punctate keratopathy, vernal keratoconjunctivitis
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Henoch-Schönlein purpura, systemic lupus erythematosus
Rheumatology/Immunology/Allergy	Atopic dermatitis, Behcet's disease, Henoch-Schönlein purpura, immune reconstitution inflammatory syndrome, keratoconjunctivitis sicca, reactive arthritis, Reiter's syndrome, relapsing polychondritis, rheumatoid arthritis, rheumatoid vasculitis, sicca syndrome, Sjögren's syndrome, systemic lupus erythematosus, vasculitis
Sexual	No underlying causes
Trauma	Injury
Urologic	No underlying causes
Miscellaneous	Connexin

Causes in Alphabetical Order

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^[1]

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^[2]

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^[2]^[3]

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^[2]

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

Epithelial herpes simplex keratitis is considered an absolute contraindication to the use of the following medications:

References

↑ "= bacterial keratitis ppp 2013".
↑ ^2.0 ^2.1 ^2.2 Thomas PA, Geraldine P (2007). "Infectious keratitis". Curr Opin Infect Dis. 20 (2): 129–41. doi:10.1097/QCO.0b013e328017f878. PMID 17496570.
↑ Dart JK, Saw VP, Kilvington S (2009). "Acanthamoeba keratitis: diagnosis and treatment update 2009". Am J Ophthalmol. 148 (4): 487–499.e2. doi:10.1016/j.ajo.2009.06.009. PMID 19660733.

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

Facts About the Cornea and Corneal Disease The National Eye Institute (NEI)
Filimentary keratitis

Template:WikiDoc Sources

[1] "= bacterial keratitis ppp 2013".

[pmid17496570-2] 2.0 ^2.1 ^2.2 Thomas PA, Geraldine P (2007). "Infectious keratitis". Curr Opin Infect Dis. 20 (2): 129–41. doi:10.1097/QCO.0b013e328017f878. PMID 17496570.

[pmid19660733-3] Dart JK, Saw VP, Kilvington S (2009). "Acanthamoeba keratitis: diagnosis and treatment update 2009". Am J Ophthalmol. 148 (4): 487–499.e2. doi:10.1016/j.ajo.2009.06.009. PMID 19660733.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{DiseaseDisorder infobox |
    Name        = Keratitis |
@@ Line 7: / Line 8: @@
 }}
 {{Search infobox}}
-{{CMG}}; {{AE}} {{MM}}
+{{CMG}}; {{AE}} {{MM}}, {{Ochuko}}, {{Faizan}}
 ==Overview==
-'''Keratitis''' is a condition in which the [[eye]]'s [[cornea]] is inflamed.
+'''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.
-==Types==
+==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.
-==Causes==
+==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.
@@ Line 36: / Line 36: @@
 *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]], [[Doxorubicin Hydrochloride]], [[Moxifloxacin ophthalmic]], [[Naphazoline]] , [[Nitisinone]], [[Panitumumab]], [[Pramipexole]]
+*Drug Induced -  [[Afatinib]], [[Cyclopentolate]], [[Diclofenac (ophthalmic)]], [[Doxorubicin Hydrochloride]], [[Emedastine Difumarate]], [[Moxifloxacin ophthalmic]], [[Naphazoline]] , [[Nitisinone]], [[Panitumumab]], [[Pramipexole]]
-==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]].
+==Causes==
+===Life Threatening Causes===
+Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
-==Treatment==
+*[[Small pox]]
-Treatment depends on the cause of the keratitis.
+===Common Causes===
+*[[Adenovirus]]
+*[[Contact lens]]
+*[[Herpes simplex virus]]
+*[[Injury]]
-Infectious keratitis generally requires antibacterial, antifungal, or antiviral therapy is to treat the infection. This treatment can involve prescription eye drops, pills, or even intravenous therapy.  Over-the-counter eye drops are typically not helpful in treating infections. In addition, contact lens wearers are typically advised to discontinue contact lens wear and discarding contaminated contact lenses and contact lens cases.  Antibacterial solutions include Quixin ([[levofloxacin]]), Zymar ([[gatifloxacin]]), Vigamox ([[moxifloxacin]]), Ocuflox ([[ofloxacin]] &mdash; available generically). Steroid containing medications should not be used for bacterial infections, as they may exacerbate the disease and lead to severe corneal ulceration and corneal perforation. These include Maxitrol ([[neomycin]]+[[polymyxin]]+[[dexamethasone]] &mdash; available generically), as well as other steroid medications. One should consult a qualified Ophthalmologist for treatment of an eye condition.
+===Causes by Organ System===
-Some infections may scar the cornea to limit vision. Others may result in perforation of the cornea, [[endophthalmitis]] (an infection inside the eye), or even loss of the eye. With proper medical attention, infections can usually be successfully treated without long-term visual loss.
-{| style="background: #FFFFFF;"
+{|style="width:80%; height:100px" border="1"
-| valign=top |
+|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;"
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Amaurosis fugax]], [[rheumatoid vasculitis]], [[vasculitis]]
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bacterial Keratitis}}
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
+|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
+|bgcolor="Beige"| [[water pollution|Contaminated water]], [[jellyfish|jellyfish stings]], [[phosgene oxime]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Acute'''''
+|-bgcolor="LightSteelBlue"
+| '''Dental'''
+|bgcolor="Beige"| No underlying causes
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] eye drops 1 gtt tid'''''
+|-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]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Contact lens use'''''
+|-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]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 0.3% eye drops hourly x 24–72 hrs then taper based on clinical response'''''<BR> OR <BR>▸ '''''[[Levofloxacin]] 0.5% eye drops hourly x 24–72 hrs then taper based on clinical response
+|-bgcolor="LightSteelBlue"
+| '''Ear Nose Throat'''
+|bgcolor="Beige"| [[Cogan syndrome]], [[ectrodactyly-ectodermal dysplasia-cleft syndrome]], [[keratitis-ichthyosis-deafness syndrome]], [[KID syndrome]], [[oculovestibuloauditory syndrome]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Immunosuppression- diabetic'''''
+|-bgcolor="LightSteelBlue"
+| '''Endocrine'''
+|bgcolor="Beige"| [[Graves' disease]], [[Graves ophthalmopathy]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 0.3% eye drops hourly x 24–72 hrs then taper based on clinical response
+|-bgcolor="LightSteelBlue"
+| '''Environmental'''
+|bgcolor="Beige"| [[water pollution|Contaminated water]], [[ultraviolet radiation]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
+|-bgcolor="LightSteelBlue"
+| '''Gastroenterologic'''
+|bgcolor="Beige"|[[Phycomycosis]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Acute'''''
+|-bgcolor="LightSteelBlue"
+| '''Genetic'''
+|bgcolor="Beige"| [[Epidermolysis bullosa]], [[facioscapulohumeral muscular dystrophy]], [[ichthyosis]], [[incontinentia pigmenti]], [[xeroderma pigmentosum]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gatifloxacin]] 1-2 gtts q2h while awake x 2 days, then q4h x 3-7 days.'''''
+|-bgcolor="LightSteelBlue"
+| '''Hematologic'''
+|bgcolor="Beige"|[[Henoch-Schönlein purpura]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Contact lens use'''''
+|-bgcolor="LightSteelBlue"
+| '''Iatrogenic'''
+|bgcolor="Beige"|[[Radial keratotomy]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Tobramycin]] 0.3% solution hourly x24–72 hrs, then taper based on clinical response'''''<BR> OR <BR>▸'''''[[Gentamicin]] 0.3% solution hourly x24–72 hrs, then taper based on clinical response'''''
+|-bgcolor="LightSteelBlue"
-|-
+| '''Infectious Disease'''
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | '''''Immunosuppression- diabetic'''''
+|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]]
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 50 mg/mL solution hourly x24–72 hrs, then taper based on clinical response'''''<BR> PLUS <BR>'''''[[Ceftazidime]] 50 mg/mL  solution hourly x24–72 hrs, then taper based on clinical response'''''
-|-
-|}
-|}
-{| style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Fungal Keratitis}}
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
+|-bgcolor="LightSteelBlue"
+| '''Musculoskeletal/Orthopedic'''
+|bgcolor="Beige"|[[Facioscapulohumeral muscular dystrophy]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Natamycin]] 5% eye drops q1–2 hrs x 3-4 days, then one drop q3-4h x 14 to 21 days or until resolution of keratitis'''''
+|-bgcolor="LightSteelBlue"
+| '''Neurologic'''
+|bgcolor="Beige"| [[Amaurosis fugax]], [[facial nerve paralysis]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
+|-bgcolor="LightSteelBlue"
+| '''Nutritional/Metabolic'''
+|bgcolor="Beige"| [[Ribonucleotide reductase]], [[type II tyrosinemia]], [[vitamin A deficiency]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] (0.05–0.15%) eye drops, q1h, then slow taper based on clinical response'''''
+|-bgcolor="LightSteelBlue"
+| '''Obstetric/Gynecologic'''
+|bgcolor="Beige"| No underlying causes
 |-
-|}
+|-bgcolor="LightSteelBlue"
-|}
+| '''Oncologic'''
-{| style="background: #FFFFFF;"
+|bgcolor="Beige"| No underlying causes
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Protozoan keratitis (Acanthameba keratitis)}}
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Chlorhexidine]] plus [[PAPB|Polyhexamethylene biguanide]] 0.02% 1gtt q1h for first week, then subsequent taper over 3 - 4 weeks'''''
+|-bgcolor="LightSteelBlue"
+| '''Ophthalmologic'''
+|bgcolor="Beige"| [[Amaurosis fugax]], [[arc eye]], [[Cogan syndrome]], [[confocal laser scanning microscopy]], [[conjunctivitis]], [[contact lens acute red eye]], [[contact lens]], [[corneal dystrophy]], [[corneal transplantation]], [[corneal ulcer]], [[dry eyes]], [[ectropion]], [[exophthalmos]], [[fungal keratitis]], [[Graves ophthalmopathy]], [[keratitis-ichthyosis-deafness syndrome]], [[keratoconjunctivitis sicca]], [[keratoconjunctivitis]], [[KID syndrome]], [[lagophthalmos]], [[LASIK]], [[late congenital syphilitic oculopathy]], [[ocular rosacea]], [[oculotect]], [[oculovestibuloauditory syndrome]], [[orthokeratology]], [[pannus]], [[phlyctenular keratoconjunctivitis]], [[photokeratitis]], [[radial keratotomy]], [[ReNu]], [[scleritis]], [[snow blindness]], [[superior limbic keratoconjunctivitis]], [[Thygeson's superficial punctate keratopathy]], [[vernal keratoconjunctivitis]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align= Left | ''OR''
+|-bgcolor="LightSteelBlue"
+| '''Overdose/Toxicity'''
+|bgcolor="Beige"| No underlying causes
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Biguanide]]-[[chlorhexidine]] plus [[propamidine]] 0.1 % or [[hexamidine]] 0.1 % 1gtt q1h for first week, then subsequent taper over 3 - 4 weeks'''''<ref name="pmid17996208">{{cite journal| author=Lim N, Goh D, Bunce C, Xing W, Fraenkel G, Poole TR et al.| title=Comparison of polyhexamethylene biguanide and chlorhexidine as monotherapy agents in the treatment of Acanthamoeba keratitis. | journal=Am J Ophthalmol | year= 2008 | volume= 145 | issue= 1 | pages= 130-5 | pmid=17996208 | doi=10.1016/j.ajo.2007.08.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17996208  }} </ref>
+|-bgcolor="LightSteelBlue"
-|}
+| '''Psychiatric'''
-|}
+|bgcolor="Beige"| No underlying causes
-{| style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Viral keratitis}}
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
+|-bgcolor="LightSteelBlue"
+| '''Pulmonary'''
+|bgcolor="Beige"| No underlying causes
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Herpes simplex]]'''''
+|-bgcolor="LightSteelBlue"
+| '''Renal/Electrolyte'''
+|bgcolor="Beige"| [[Henoch-Schönlein purpura]], [[systemic lupus erythematosus]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trifluridine]] eye drops, q1-2 hours up to 9 drops/day until re-epithelialization, then one drop q4h for a total course up to 21 days'''''
+|-bgcolor="LightSteelBlue"
+| '''Rheumatology/Immunology/Allergy'''
+|bgcolor="Beige"| [[Atopic dermatitis]], [[Behcet's disease]], [[Henoch-Schönlein purpura]], [[immune reconstitution inflammatory syndrome]], [[keratoconjunctivitis sicca]], [[reactive arthritis]], [[Reiter's syndrome]], [[relapsing polychondritis]], [[rheumatoid arthritis]], [[rheumatoid vasculitis]], [[sicca syndrome]], [[Sjögren's syndrome]], [[systemic lupus erythematosus]], [[vasculitis]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Varicella-zoster]]'''''
+|-bgcolor="LightSteelBlue"
+| '''Sexual'''
+|bgcolor="Beige"| No underlying causes
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Famciclovir]] 500 mg po tid  x 10 days'''''<BR>''OR''<BR>▸ '''''[[Valacyclovir]] 1 gm po tid x 10 days'''''
+|-bgcolor="LightSteelBlue"
+| '''Trauma'''
+|bgcolor="Beige"| [[Injury]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
+|-bgcolor="LightSteelBlue"
+| '''Urologic'''
+|bgcolor="Beige"| No underlying causes
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Herpes simplex]]'''''
+|-bgcolor="LightSteelBlue"
+| '''Miscellaneous'''
+|bgcolor="Beige"|[[Connexin]]
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vidarabine]] ointment 5 times per day x 21 days (currently discontinued in U.S.)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''[[Varicella-zoster]]'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Acyclovir]] 800 mg po 5 times/day x 10 days'''''
-|}
 |}
+===Causes in Alphabetical Order===
+{{columns-list|
+*[[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====
@@ Line 148: / Line 432: @@
 {{MedCondContrAbs
-|MedCond = Epithelial herpes simplex keratitis|Fluorometholone|Loteprednol|Suprofen}}
+|MedCond = Epithelial herpes simplex keratitis|Fluorometholone|Loteprednol|Rimexolone|Suprofen}}
+==References==
+{{Reflist}}
-==See also==
+==Related Chapters==
 *[[List of eye diseases and disorders]]
 *[[List of systemic diseases with ocular manifestations]]
@@ Line 156: / Line 443: @@
 *Chronic superficial keratitis, or pannus, for the disease in dogs
-==External links==
+==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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-[[es:Queratitis]]
-[[hr:Keratitis]]
-[[it:Cheratite]]
-[[nl:Keratitis]]
-[[pt:Ceratite]]
-[[ru:Кератит]]
-[[tr:keratit]]
-[[uk:Кератит]]
-[[zh:角膜炎]]
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