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What Is Bacterial Keratitis?

Bacterial keratitis is an acute corneal infection caused by bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus species. The organisms invade the corneal epithelium and stroma and create an ulcer with surrounding inflammation. It is a true eye emergency because damage can progress quickly. Contact lens overuse, trauma, and ocular surface disease are common backgrounds. Without fast treatment, bacterial keratitis can lead to scarring, perforation, and serious vision loss.

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What Is Bacterial Keratitis?

Bacterial keratitis is an acute corneal infection caused by bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus species. The organisms invade the corneal epithelium and stroma and create an ulcer with surrounding inflammation. It is a true eye emergency because damage can progress quickly. Contact lens overuse, trauma, and ocular surface disease are common backgrounds. Without fast treatment, bacterial keratitis can lead to scarring, perforation, and serious vision loss.

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Causes and Risk Factors for Bacterial Keratitis

Soft contact lens wear, especially overnight or with poor hygiene, is one of the leading risk factors. Trauma with foreign bodies, prior ocular surgery, and chronic surface disease such as exposure keratopathy or severe dry eye also predispose the cornea to infection. Topical steroid use, lid margin disease, and systemic immunosuppression further increase risk. Different organisms are linked to different settings, such as Pseudomonas in lens wearers and gram positive cocci in eyes with lid disease.

Symptoms and Clinical Features

Symptoms usually develop rapidly over hours to days. Patients report pain, redness, tearing, discharge, and blurred vision. On slit lamp exam, there is a focal or diffuse stromal infiltrate with an overlying epithelial defect, surrounding edema, and often a hypopyon. The ulcer edges can look well defined or fluffy depending on the organism. Adjacent conjunctiva is injected, and the anterior chamber may show cells and flare. The appearance plus history helps guide initial therapy while cultures are pending.

How Is Bacterial Keratitis Diagnosed?

Diagnosis begins with careful history and slit lamp examination. The doctor notes risk factors, onset, and contact lens habits. Corneal scrapings are taken for Gram stain and culture before starting strong antibiotics, especially in larger or central ulcers. Sensitivity testing guides later adjustments. In smaller peripheral cases, empirical treatment may start without cultures, but close follow up is still needed. Imaging is used mainly in atypical or deep lesions.

How Is Bacterial Keratitis Treated?

Treatment requires intensive topical antibiotics, often with fortified drops in severe cases. Fluoroquinolone monotherapy is used for many moderate ulcers, while combinations with fortified aminoglycosides or cephalosporins are chosen for more severe disease. Drops are given very frequently at first, including overnight, then tapered as the ulcer stabilizes. Cycloplegics help with pain and ciliary spasm. Once infection is under control, cautious use of topical steroids is sometimes added to limit scarring in selected cases.

FAQs About Bacterial Keratitis

How urgent is bacterial keratitis?

It is an ocular emergency. Corneal tissue can melt quickly, sometimes within days, so prompt evaluation and strong antibiotic treatment are very important to preserve sight.

Should I stop wearing contact lenses if bacterial keratitis is suspected?

Yes, lenses are removed immediately and not worn until the infection has fully resolved and the doctor approves. The lenses and case are usually discarded to avoid recontamination.

Can bacterial keratitis heal without scarring?

Small, peripheral ulcers can heal with minimal scarring, while large or central ulcers often leave some opacity. Early treatment improves the chance of a clearer outcome.

Why are cultures taken before starting drops?

Cultures identify the organism and guide antibiotic selection. Starting treatment right away is important, but having culture results helps refine therapy if the early response is not as expected.