Infectious Keratitis

Keratitis is an inflammation of the cornea, which can lead to corneal opacification or ulceration. The most common cause of infectious keratitis is herpes simplex virus type 1 (HSV-1). Noninfectious corneal infiltrates related to trauma, collagen vascular disease, autoimmune inflammation, vasculitis, or atopy (which predisposes to HSV keratitis) must be considered. HSV-associated stromal keratitis is the most common cause of infectious corneal blindness in the United States, yet its presentation can be fairly subtle. For this reason, symptoms out of proportion to exam findings or a history concerning for viral infection is an indication for prompt referral to ophthalmology. Topical antibiotic drops achieve high tissue concentrations and are the treatment of choice. Empiric coverage should be prescribed and tailored later under the care of an ophthalmologist. Other keys to effective treatment include discontinuing contact lens use and protecting the eye with a rigid shield without a patch, as patching provides a reservoir for infection.