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Pathogens

• Bacteria: Pseudomonas , Staphylococcus aureus, Streptococci (S. pyogenes, S. pneumoniae)
• Acanthamoeba
• Fungi: Candida, Fusarium, Aspergillus

Work-up

• Photodocumentation
• Specimen collection for:
  • Infiltrate >1mm or involving the central visual axis or no response to initial therapy
  • For non-central infiltrate <1mm: Swab not mandatory, low likelihood of pathogen detection
  • Optimal: Direct examination, culture for bacteria + fungi, +/- viral PCR (HSV, VZV)
• Consider sending in contact lens case including contact lens to microbiology
  • Especially if Acanthamoeba is suspected, otherwise not very helpful as cases are often contaminated

Treatment

• depending on suspected pathogen
  • Bacterial Keratitis
  • Fungal Keratitis
  • Acanthamoeba Keratitis

Follow-up

• daily until improvement
• Cave: Avoid contact lens use until fully healed (preferably 1 week longer after therapy cessation)

Sources

• EyeWiki Contact lens complications
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
• ¹ Foto: Seraina Tscharner