Materiały źródłowe

• #1 Keratitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/561

  Keratitis is an ocular emergency and remains one of the major causes of blindness around the world. […] The diagnosis depends on a careful history, slit-lamp examination, and corneal scraping cultures. […] Key diagnostic factors include corneal infiltrate, corneal ulcer, dendritic or geographic epithelial lesion, periocular skin lesions, multifocal corneal ulcer with feathery edges, corneal perineuritis, and interstitial keratitis. […] Other diagnostic factors include redness, pain, increased lacrimation, lid edema, discharge, decreased visual acuity, photophobia, high intraocular pressure, history of herpes simplex virus or varicella zoster virus infection, multiple old stromal scars, iris transillumination, and corneal hypoesthesia. […] 1st tests to order include corneal scraping: microscope slide and corneal scraping: cultures and sensitivity. […] Tests to consider include CBC, HIV test, autoimmune testing, and corneal scraping: polymerase chain reaction (PCR) testing.

• #1 Keratitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/keratitis/diagnosis-treatment/drc-20374114

  Diagnosing keratitis typically involves the following: […] Eye exam. Although it may be uncomfortable to open your eyes for the exam, it’s important to have your eye care provider examine your eyes. […] Penlight exam. Your eye doctor may examine your eye using a penlight, to check your pupil’s reaction, size and other factors. A stain may be applied to the surface of your eye. Used with the light, this stain makes it easier to see damage to the surface of the cornea. […] Slit-lamp exam. Your eye care provider will examine your eyes with a special instrument called a slit lamp. It provides a bright source of light and magnification to detect the character and extent of keratitis, as well as the effect it may have on other structures of the eye. […] Laboratory analysis. Your eye care provider may take a sample of tears or some cells from your cornea for laboratory analysis to determine the cause of keratitis and to help develop a treatment plan for you.

• #1 Keratitis: A Complete Guide – Burman & Zuckerbrod Ophthalmology Associates

  https://www.2020detroit.com/keratitis-a-complete-guide/

  Keratitis may be diagnosed after a physical examination by an eye care professional such as an ophthalmologist, who will look at the condition of the eye, taking note of redness or discharge, and ask the patient about any other symptoms, such as pain or blurry vision. […] A slit lamp may be used to take a closer look at the eye, specifically the cornea. A slit lamp is a tool that has a high-intensity light and a microscope. […] During examination with a slit lamp, patients sit with their chin and forehead supported, while the examiner shines the light into the eye and looks closely at it with the microscope. […] Because keratitis can be caused by bacteria, a culture may also be taken. Anesthetic eye drops may be administered, and the culture is taken by gently scraping the cornea with a sterile spatula. A sample of any discharge or tears from the eye may also be collected and sent out for culture.

• #1 Keratitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559014/

  Keratitis is a clinical entity wherein inflammatory cells infiltrate different corneal layers in response to noxious stimuli, either infectious exogenous agents or self-antigens. […] This activity helps clinicians identify the etiological agent at the earliest based on clinical features and appropriate diagnostic tests and manage these patients with the latest treatment options. […] Keratitis is the inflammation of the cornea and is characterized by corneal edema, infiltration of inflammatory cells, and ciliary congestion. […] The routine protocol for any corneal ulcer is to look for the characteristic features of the ulcer, followed by corneal scraping to identify the causative organism. […] The patient is started on medications based on direct microscopy findings, and subsequently, the treatment is further modified based on culture reports. […] The diagnosis of keratitis is not difficult; however, finding the etiology is not always easy.

• #1 Keratitis – What You Need to Know

  https://www.drugs.com/cg/keratitis.html

  How is keratitis diagnosed? […] Your healthcare provider will ask about your symptoms and when they started. You may also need any of the following: […] An eye exam to check your vision, or to look for a foreign object or any tears in your cornea. Eye pressure may also be checked. Numbing medicine may be given. […] A slit-lamp exam is a procedure used to check the inside of your eye. Your healthcare provider shines a bright light in your eye. You may need eyedrops to dilate your pupils.

• #1 Diagnosis And Management Of Nocardia Keratitis GlobalRPH

  https://globalrph.com/2021/01/diagnosis-and-management-of-nocardia-keratitis/

  Keratitis refers to infection of the cornea, the dome covering the eyes iris and pupil. […] The diagnosis of Nocardia keratitis is often missed or delayed due to the rarity and the clinical profiles resemblance to fungal keratitis. […] A comprehensive ocular examination is the first stage. This includes vision tests, ocular motility test, pupillary assessment, and recording intraocular pressure. […] History taking is the first step in making an Nocardia keratitis diagnosis. Ophthalmologists collect information on previous eye injury or surgery, and treatments used. […] The laboratory diagnosis starts with corneal scraping and/or biopsy where a Kimura spatula or a No.15 surgical blade is used to take samples from the cornea. […] The corneal scrapings are smeared, stained, and then examined under a confocal microscope.

• #1 Updates in Diagnostic Imaging for Infectious Keratitis: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10647798/

  Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. […] The culture of corneal scrapings is the gold standard for diagnosis and to identify and isolate the causal organism of the infection. […] Infectious keratitis is diagnosed using the patients history, clinical examination under a slit lamp and the microbiology results from staining and culture of the scrapings from the corneal ulcer. […] The key to making the diagnosis is the identification of key features on slit lamp examination with fluorescein staining. […] Slit lamp biomicroscopy is used in determining the severity of the infection.

• #1 Bacterial Keratitis – EyeWiki

  https://eyewiki.org/Bacterial_Keratitis

  Bacterial keratitis is a serious bacterial infection of the cornea which can, in severe cases, cause loss of vision. […] A diagnosis of bacterial keratitis should include a detailed history and a complete ophthalmic examination. […] Diagnosis is based on clinical history and slit lamp examination showing the presence of a corneal infiltrate. […] Corneal scraping for Gram and Giemsa staining and cultures are performed to determine the causative organism in all ulcers that are either large (2mm), involve the middle to deep stroma, are sight threatening, are chronic in nature, are atypical, or are unresponsive to treatment. […] The differential diagnosis of bacterial keratitis is large. Other infectious etiologies must be considered.

• #1

  https://www.aao.org/eye-health/glasses-contacts/what-is-bacterial-keratitis

  To diagnose bacterial keratitis, your ophthalmologist will discuss your symptoms with you. They may gently scrape the eye to take a small sample and test it for infection. […] Bacterial keratitis is usually treated with antibiotic eye drops. Drops are usually put in frequently. Treatment may also involve steroid drops. You may need to return to your ophthalmologist several times. […] If you and your ophthalmologist find and treat bacterial keratitis early, you may preserve your vision. In severe cases, decreased vision or blindness may be the result. This is also true if the infection affects the center of the cornea. Sometimes a cornea transplant or specialized contact lens is needed to restore vision.

• #1 From Clinical Suspicion to Diagnosis: A Review of Diagnostic Approaches and Challenges in Fungal Keratitis

  https://www.mdpi.com/2077-0383/13/1/286

  From Clinical Suspicion to Diagnosis: A Review of Diagnostic Approaches and Challenges in Fungal Keratitis […] Fungal keratitis is a relatively rare yet severe ocular infection that can lead to profound vision impairment and even permanent vision loss. Rapid and accurate diagnosis plays a crucial role in the effective management of the disease. A patient’s history establishes the initial clinical suspicion since it can provide valuable clues to potential predisposing factors and sources of fungal exposure. […] Definitive diagnosis is established through appropriate microbiological investigations. Direct microscopic examination of corneal scrapings or biopsy specimens can assist in the presumptive diagnosis of fungal keratitis, but culture remains the gold standard for diagnosing fungal keratitis. […] The differential diagnosis of fungal keratitis involves distinguishing it from other forms of infectious keratitis that may exhibit similar signs but often respond to different treatment regimens. […] The purpose of this review is to provide an overview of the journey from initial clinical suspicion to reaching a definitive diagnosis. […] While a definitive diagnosis is often established through appropriate microbiological investigations, a patient’s history and clinical examination findings establish the initial clinical suspicion. The diagnosis of fungal keratitis starts with a strong clinical suspicion. […] A thorough clinical history provides valuable clues regarding potential predisposing factors and sources of fungal exposure. […] It is crucial to emphasize that the symptoms observed are not exclusive to fungal keratitis; they can be encountered in different types of infectious keratitis. […] Thorough clinical examination of the affected eye can assist in making a diagnosis before microbiological testing or in its absence. […] In cases where mycotic keratitis is strongly suspected, the diagnostic algorithm proceeds with microbiological investigations aimed at identifying the specific causative agent. […] Direct microscopic examination of corneal scrapings or biopsy specimens can assist in rapid and cost-effective presumptive diagnosis of fungal keratitis. […] While direct microscopy provides a rapid result to clinicians for starting initial therapy, the culture of corneal samples remains the gold standard for diagnosis of fungal keratitis. […] The significant limitations associated with conventional microbiological investigations have prompted the advancement of molecular techniques as diagnostic tools for fungal keratitis. […] The speed and accuracy of PCR advocate for its widespread application in the diagnosis of fungal keratitis. […] Non-invasive methods of diagnosis include in vivo confocal microscopy (IVCM) and optical coherence tomography (OCT). […] In conclusion, the diagnosis of fungal keratitis represents a crucial aspect in the effective management of this potentially vision-threatening condition.

• #1 Fungal keratitis: Diagnosis, management and recent advances | OPTH

  https://www.dovepress.com/fungal-keratitis-diagnosis-management-and-recent-advances-peer-reviewed-fulltext-article-OPTH

  Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. […] Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. […] It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. […] Clinical signs of fungal keratitis are valuable in giving an initial diagnosis, but confirmation of the diagnosis and identification of the causative organism requires other diagnostic tests, including microbiological laboratory tests. […] The first step for laboratory tests is corneal scraping to obtain tissues for examination and culture. […] Examination of corneal smears using direct microscopy is an important initial step in laboratory diagnosis.

• #1 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  Herpes simplex virus (HSV) keratitis remains primarily a clinical diagnosis based on characteristic features of the corneal lesion. […] Laboratory studies may help to confirm the clinical suspicion in cases lacking typical findings, but they are not readily available in most clinical settings. […] If the diagnosis is in doubt, however, laboratory diagnosis can be made using the following: Giemsa stain – Scrapings of the corneal or skin lesions show multinucleated giant cells. […] Papanicolaou stain – This shows intranuclear eosinophilic inclusion bodies. […] Viral culture. […] Immunohistochemistry looking for viral antigens. […] Polymerase chain reaction (PCR) assay. […] Epithelial scrapings with Giemsa stain may show multinucleated giant cells, resulting from coalescence of infected corneal epithelial cells and intranuclear viral inclusions.

• #1 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  However, negative cytology results do not exclude HSV infection. […] Viral cultures obtained within several days of onset of disease and prior to antiviral therapy have a sensitivity of up to 70% and also allow for identification of the HSV subtypes. […] Various techniques (eg, conventional tube culture, shell vial assay, suspension infection method) are available. […] HSV-antigen detection tests, such as the enzyme-linked virus-inducible system (ELVIS), are very specific for detecting herpes infection, but they are limited by their lower sensitivity. […] Cell culture for confirmation of HSV is recommended when the ELVIS test result is negative. […] PCR assay using tear samples, corneal epithelium, anterior chamber tap, or corneal buttons may detect viral DNA in cases of herpetic keratitis or keratouveitis.

• #1 Clinical Overview of Acanthamoeba Keratitis | Acanthamoeba Infections | CDC

  https://www.cdc.gov/acanthamoeba/hcp/clinical-overview-acanthamoeba-keratitis/index.html

  Early diagnosis is essential for effective treatment of Acanthamoeba keratitis. […] The first step in diagnosing Acanthamoeba keratitis is to have a high degree of suspicion since the disease can cause permanent vision loss. […] An early diagnosis offers the best chance of a cure. A diagnosis of Acanthamoeba keratitis is usually based on symptoms, detection of the ameba from a scraping of the eye, or by seeing the ameba by a process called confocal microscopy. […] A diagnosis of Acanthamoeba keratitis can be made through isolation of organisms from corneal culture, detection of trophozoites and cysts on histopathology, or detection of Acanthamoeba with a polymerase chain reaction (PCR) test. Confocal microscopy may also assist with diagnosis.

• #1 Diagnosis of Acanthamoeba Keratitis: Past, Present and Future

  https://www.mdpi.com/2075-4418/13/16/2655

  In AK, IVCM has been shown to be a valuable diagnostic modality. Compared to culture and PCR, IVCM exhibits a superior diagnostic performance, having an overall sensitivity of 77–100% and specificity of 84–100%. […] The diagnosis of AK remains challenging. Early diagnosis of AK is essential to ensure prompt treatment and good clinical outcomes. Traditionally, conventional culture and microscopy were considered to be the gold standard for diagnosing AK, but emerging evidence regarding PCR and IVCM have supported their diagnostic utility in treating AK in the clinic.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Keratitis-Diagnosed.aspx

  Physicians employ both traditional and new techniques to diagnose keratitis. […] The history of the patient is examined and diagnosis is based on the eye examination. […] Depending on the diagnosis required, physicians decide on the type of samples to be collected. […] The collected samples are tested using a variety of stain methods for smears. […] Laboratory testing is not usually carried out for viral keratitis, except to confirm the presence of viruses such as HSV-1. […] Indirect immunoperoxidase (IP) assays and immunofluorescence (IF) both direct and indirect categories are used in the diagnosis of viral pathogens. […] While primary results of the samples are obtained using the smear method, confirmation of the disease is done by carrying out culture isolation. […] Prior knowledge about the suspected organism helps to select the right type of culture media. […] Confocal microscopy is a non-invasive method that helps to visualize the cornea. […] Molecular techniques such as polymerase chain reaction are used to diagnose viruses or to find organisms that take more time to grow or that are complex for the culture method.

• #1 Fungal keratitis: Diagnosis, management and recent advances | OPTH

  https://www.dovepress.com/fungal-keratitis-diagnosis-management-and-recent-advances-peer-reviewed-fulltext-article-OPTH

  KOH at a concentration of 10-20% can be used to identify fungal growth with a direct microscope. […] For the diagnosis of fungal keratitis, the isolation of fungal elements by culture is considered the most sensitive method. […] Fungal keratitis definitive diagnosis is achieved if fungal elements are seen in corneal smears. […] Corneal biopsy with diagnostic keratectomy is more diagnostic than corneal scraping for fungal keratitis. […] In vivo confocal microscopy (IVCM) is an imaging technique that provides corneal tissue real-time imaging at the corneas microstructural level. […] Polymerase chain reaction (PCR) is considered a rapid and sensitive technique in the diagnosis of mycotic keratitis. […] Artificial intelligence (AI) is a promising technology that may play a great role in the diagnosis, follow-up, and management of all types of infectious keratitis.

• #1 Updates in Diagnostic Imaging for Infectious Keratitis: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10647798/

  The advantage of the AS-OCT is its ability to accurately measure the depth and width of the corneal ulcer, infiltrates, and haze to monitor the progress of corneal pathologies, such as superficial and deep infectious keratitis. […] IVCM has mainly been used in the evaluation of fungal and Acanthamoeba keratitis (AK) due to its axial limitation of 57 m, which is not sufficient to detect bacteria (less than 5 m) and viruses (in nanometres). […] IVCM is a key diagnostic test in AK with an overall sensitivity of 80100% and specificity of 84100%. […] The overall sensitivity and specificity of IVCM for fungal keratitis are 6674% and 78100%, and for Acanthamoeba keratitis, they are 80100% and 84100%. […] Many studies have evaluated DL methods for diagnosing IK using images taken with a handheld camera, a camera mounted on a slit lamp or confocal microscopy.

• #1

  https://journals.lww.com/ijo/fulltext/2016/64050/recent_advances_in_diagnosis_and_management_of.4.aspx

  PCR has emerged as a sensitive and specific test for the diagnosis of fungal keratitis. Various studies have compared PCR with conventional diagnostic methods in cases with suspected fungal keratitis. PCR has the highest positive detection rate overall especially in cases with culture or smear-negative results. […] The advantage of PCR-based tests is that only a small clinical sample is needed for diagnosis and it is rapid. PCR assay takes 48 h, whereas positive fungal cultures require on an average of 27 days. […] The reported sensitivity of IVCM is between 80% and 94%. There are now several studies of IVCM in fungal keratitis that compared the sensitivity of cultures to IVCM and found IVCM to be superior or at par with standard diagnostic procedures. […] Management of fungal keratitis largely involves a decision on which antifungal to use and the route of administration. Current selection of antifungals is based on animal experiments, clinical experience, and published sensitivity data.

• #1 Updates in Diagnostic Imaging for Infectious Keratitis: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10647798/

  The applications of artificial intelligence in health care are now a reality due to the advancement of computational power, refinement of learning algorithms and architectures, availability of big data and easy accessibility to deep neural networks by the public. […] For infectious keratitis, the use of DL with CNNs has been shown to be a potentially more accessible diagnostic method via image recognition. […] Further work is needed to examine and validate the clinical performance of these CNNs models in real-world healthcare settings with multiethnicity populations to increase the generalisability of the model.

• #1 Deep learning for multi-type infectious keratitis diagnosis: A nationwide, cross-sectional, multicenter study | npj Digital Medicine

  https://www.nature.com/articles/s41746-024-01174-w

  Therefore, developing a method that can accurately and swiftly discern the cause of IK is crucial to helping IK patients reduce their vision loss with timely and effective treatment. […] This study developed a customized deep-learning system called DeepIK. This system could mimic the diagnostic process of a human expert in identifying bacterial, fungal, viral, amebic, and noninfectious keratitis from slit-lamp images. […] The top-performing algorithm, DeepIK, attained area under the receiver operating characteristic curves (AUCs) of 0.949, 0.970, 0.955, 0.994, and 0.979 for the classification of bacterial, fungal, viral, amebic, and noninfectious keratitis, respectively. […] DeepIK exhibited the highest performance in effectively distinguishing between various types of keratitis. […] DeepIK could potentially alleviate the substantial requirement for diagnostic expertise in cases of healthcare system overload or in remote areas where experienced ophthalmologists are scarce.

• #1 Deep learning for multi-type infectious keratitis diagnosis: A nationwide, cross-sectional, multicenter study | npj Digital Medicine

  https://www.nature.com/articles/s41746-024-01174-w

  The key to effective management of infectious keratitis hinges on prompt and precise diagnosis. […] Nevertheless, the current gold standard, such as cultures of corneal scrapings, remains time-consuming and frequently yields false-negative results. […] Our study indicates that DeepIK possesses the capability to assist ophthalmologists in accurately and swiftly identifying various infectious keratitis types from slit-lamp images, thereby facilitating timely and targeted treatment. […] Prompt detection of the cause of IK is the premise of providing targeted therapy for reducing vision loss and preventing severe complications. […] However, due to overlapping inflammatory features, even ophthalmologists have relatively poor performance in the identification of pathogenic microorganisms of IK.

• #1 Keratitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/keratitis/symptoms-causes/syc-20374110

  Keratitis may or may not be associated with an infection. […] If you have eye redness or other symptoms of keratitis, make an appointment to see an eye specialist. […] Delays in diagnosis and treatment of keratitis can lead to serious complications, including blindness. […] If you notice any of the symptoms of keratitis, make an appointment to see an eye specialist right away. […] Keratitis is more common in people who use extended-wear contacts, or wear contacts continuously, than in those who use daily wear contacts and take them out at night. […] Use of corticosteroid eye drops to treat an eye disorder can increase your risk of developing infectious keratitis or make existing keratitis worse. […] Potential complications of keratitis include temporary or permanent reduction in your vision. […] Proper use, cleaning and disinfecting can help prevent keratitis. […] Follow your eye care provider’s recommendations for taking care of your lenses.

• #1 Fungal keratitis: Diagnosis, management and recent advances | OPTH

  https://www.dovepress.com/fungal-keratitis-diagnosis-management-and-recent-advances-peer-reviewed-fulltext-article-OPTH

  Misdiagnosis is mainly due to some ophthalmologists lack of experience with differentiating clinical signs between different types of microbial keratitis. […] The management of corneal fungal infections is primarily medical. […] The use of antifungal medications is considered the main treatment for fungal keratitis. […] Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. […] The main surgical procedure accepted for the management of fungal keratitis is therapeutic keratoplasty. […] Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal dosing below its therapeutic level. […] Collagen cross-linking (CXL) is proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications.

• #1 Acanthamoeba Keratitis: Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/21560-acanthamoeba-keratitis

  Acanthamoeba keratitis (AK) is a rare parasitic eye infection from a certain type of amoeba. It affects the cornea, the clear, dome-shaped front covering of your eye. When not treated, it can damage your eyes and cause loss of sight. […] AK is tricky to diagnose early on, and an initial misdiagnosis happens in about 75% to 90% of cases. […] Your eye care specialist will do an eye exam, including a slit lamp exam. That lets them look into your eyes for signs or clues. […] The standard practice is to treat any eye infection as if it were viral or bacterial first and suspect its AK if treatment doesn’t work. […] Testing for AK may involve taking samples of corneal tissue. […] The main form of treatment is topical antiseptic drops, such as chlorhexidine and polihexanide (also known as polyhexamethylene biguanide, or PHMB).

• #1 Peripheral ulcerative keratitis diagnosis and management – EyeWorld

  https://www.eyeworld.org/2024/peripheral-ulcerative-keratitis-diagnosis-and-management/

  Peripheral ulcerative keratitis (PUK) is a clinical diagnosis, said Sanjay Kedhar, MD. Patients may present with pain, redness, tearing, photophobia, or changes in vision. Slit lamp exam typically reveals a crescentic epithelial defect with stromal thinning in the peripheral cornea. He added that in severe cases, the patient may present with a descemetocele or frank perforation of the cornea due to progressive stromal destruction and thinning. […] Slit lamp exam is imperative, as this is primarily a clinical diagnosis, Dr. Ahmad said. Exam will show a peripheral infiltrate adjacent to the limbus, often crescent shaped, with an overlying epithelial defect. Patient presentations can range from barely symptomatic to severe eye pain, redness, photophobia, and irritation. […] Since PUK is typically associated with an underlying autoimmune condition, Dr. Ahmad said an appropriate review of systems should be done followed by a targeted lab workup looking for autoimmune, rheumatic, and infectious causes. Corneal culture should be considered prior to initiating antibiotics to rule out the possibility of infectious keratitis.

• #1 Peripheral ulcerative keratitis diagnosis and management – EyeWorld

  https://www.eyeworld.org/2024/peripheral-ulcerative-keratitis-diagnosis-and-management/

  A thorough history and physical exam is a key component of the workup, Dr. Kedhar said. Cultures from the bed of the lesion should be performed if an infection is suspected. […] Dr. Ahmad said there may be some challenges with confirming a diagnosis because many other conditions can mimic PUK. He expanded on the differential diagnosis to also include infectious keratitis, herpes viral keratitis, and staph marginal keratitis. Differentiating between these entities can be challenging and requires a careful history and physical exam, he said. […] Dr. Kedhar said that treatment of PUK will be based on the nature of the underlying disease. For autoimmune disorders, treatment consists of local and systemic treatment. Local therapy includes aggressive lubrication of the eye with preservative-free artificial tears and punctal occlusion to promote epithelial healing as well as oral doxycycline and vitamin C.

• #1 CRST Global | Neurotrophic Keratitis: Diagnosis, Management, and Future Directions

  https://crstodayeurope.com/articles/issue01-2025/neurotrophic-keratitis-diagnosis-management-and-future-directions/

  A nuanced understanding of NK’s pathophysiology and progression is essential for timely diagnosis and targeted therapeutic intervention to preserve patients’ vision and corneal health. […] Diagnosing NK can be particularly challenging in its early stages because it often mimics common forms of ocular surface disease (OSD) such as dry eye. The hallmarks of the underlying pathophysiology of NK—reduced corneal neuron activity—include diminished tear production and delayed epithelial healing. […] The key sign of NK is a marked reduction in corneal sensation, which can be assessed with tools such as an esthesiometer, cotton swab, or dental floss. Patients may report minimal discomfort despite significant corneal findings such as punctate epithelial erosions and persistent defects. NK often presents as severe unilateral punctate keratopathy that is out of proportion to the patients’ symptoms.

• #1 Deep learning for multi-type infectious keratitis diagnosis: A nationwide, cross-sectional, multicenter study | npj Digital Medicine

  https://www.nature.com/articles/s41746-024-01174-w

  Given its reliable performance and the ability to swiftly provide classification results, DeepIK demonstrates a high potential to assist ophthalmologists in accurately and rapidly distinguishing among various types of IK. […] This system has the potential to aid ophthalmologists in accurately and promptly identifying the cause of IK, thereby improving patients visual prognosis through the initiation of targeted treatment at an early stage.

• #1 Keratitis: Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24500-keratitis

  Keratitis can cause discharge, bloodshot eyes and redness or discoloration of the area around the eye. Untreated inflammation of the cornea (keratitis) causes most cases of corneal blindness throughout the world despite the fact that it can be treated. […] Early signs and symptoms of keratitis include eye pain and redness. If you think you may have keratitis, you should see a healthcare provider immediately. Damage to your eyes from the disease can result in vision loss. Worldwide, keratitis causes most cases of corneal blindness. […] Your eye care provider will first ask you questions about your symptoms and medical history. Then theyll do some or all of these tests: A complete eye exam: Your provider will use bright lights and a microscope to look at your eyes. A culture of discharge from your eye: Your provider will send a swab with the discharge to a lab for identification. Fluorescein stain test: Your provider will put dye into your eye and then look at it with a blue lamp.

• #1 Keratitis: Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/keratitis

  Keratitis is an inflammation of the cornea. […] How is keratitis diagnosed? […] A thorough eye examination with a slit-lamp exam and potential use of fluorescein dye to enhance the visibility of corneal abnormalities. […] Laboratory analysis: Tears or corneal cells may be collected and sent to a lab for proper analysis. […] Like any eye condition, early treatment for keratitis is crucial. Contact your doctor for a proper diagnosis and prompt and accurate treatment if you experience eye pain with redness, swelling, difficulty opening the eye, or blurred vision.

• #1 Keratitis: Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24500-keratitis

  If you have a mild case of keratitis, your provider may suggest using lubricant eye drops and letting your eye heal on its own. However, medication normally treats infectious keratitis. If you have a bacterial infection, youll get antibiotic eye drops. If you have a fungal infection, the eye drops will contain antifungal medication. If you have a virus, your provider will prescribe antiviral eye drops. […] If you have most types of keratitis, treatment cures it. If you have a viral form of keratitis, it may come back. You may develop glaucoma as a result of infectious keratitis. The outlook for people with fungal keratitis may be worse than the outlook for people with bacterial keratitis. […] You should always contact your healthcare provider if you have eye pain along with redness, eye watering and blurred vision. If you received treatment and you arent recovering, you should contact your provider. […] With keratitis, like other eye conditions, its important to get medical help early. Contact a healthcare provider any time you have eye pain, especially if you also have redness, swelling, a problem opening your eye or blurry vision. Keratitis treatment is available.

• #1 Keratitis Causes, Treatment, Diagnosis, Types & NHS Symptoms

  https://www.medicinenet.com/keratitis/article.htm

  Treatment depends on the cause of the keratitis. Infectious keratitis generally requires antibacterial, antifungal, or antiviral therapy to treat the infection. This treatment can involve prescription eyedrops, pills, or even intravenous therapy. Any corneal or conjunctival foreign body should be removed. Wetting drops may be used if disturbance of the tears is suspected to be the cause of the keratitis. Steroid drops may be prescribed occasionally to reduce inflammation and limit scarring. This must be done carefully and judiciously since some infections can be worsened with their use. […] With proper diagnosis and appropriate treatment including follow-up care, keratitis can usually be managed without causing permanent visual disturbances. […] The risk of keratitis can be reduced through the use of precautions to avoid eye injury, careful contact-lens care including proper cleaning of contact lens cases, and the prompt treatment of early ocular symptoms.

• #2 Keratitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559014/

  Keratitis is a clinical entity wherein inflammatory cells infiltrate different corneal layers in response to noxious stimuli, either infectious exogenous agents or self-antigens. […] This activity helps clinicians identify the etiological agent at the earliest based on clinical features and appropriate diagnostic tests and manage these patients with the latest treatment options. […] Keratitis is the inflammation of the cornea and is characterized by corneal edema, infiltration of inflammatory cells, and ciliary congestion. […] The routine protocol for any corneal ulcer is to look for the characteristic features of the ulcer, followed by corneal scraping to identify the causative organism. […] The patient is started on medications based on direct microscopy findings, and subsequently, the treatment is further modified based on culture reports. […] The diagnosis of keratitis is not difficult; however, finding the etiology is not always easy.

• #2 Keratitis Causes, Treatment, Diagnosis, Types & NHS Symptoms

  https://www.medicinenet.com/keratitis/article.htm

  How do healthcare professionals diagnose keratitis? The diagnosis of keratitis is made by an ophthalmologist (a physician who specializes in diseases and surgery of the eye) through a history and a physical examination. The history consists of questions documenting a past medical and ocular history and the symptoms specific to the current visit. The eye examination will consist of checking your vision and careful inspection of the corneas using a slit lamp, which is a microscope with excellent illumination and magnification to view the entire ocular surface, including the cornea in detail. A special dye containing fluorescein in the form of eye drops may be placed in the eyes to assist with the examination. […] In cases in which infection is suspected, a culture may be taken from the surface of the eye for specific identification of the bacteria, virus, fungus, or parasite causing the keratitis. Blood tests may also be done in certain patients with suspected underlying diseases.

• #2 Updates in Diagnostic Imaging for Infectious Keratitis: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10647798/

  Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. […] The culture of corneal scrapings is the gold standard for diagnosis and to identify and isolate the causal organism of the infection. […] Infectious keratitis is diagnosed using the patients history, clinical examination under a slit lamp and the microbiology results from staining and culture of the scrapings from the corneal ulcer. […] The key to making the diagnosis is the identification of key features on slit lamp examination with fluorescein staining. […] Slit lamp biomicroscopy is used in determining the severity of the infection.

• #2 Superficial Punctate Keratitis – Eye Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/eye-disorders/corneal-disorders/superficial-punctate-keratitis

  Superficial punctate keratitis is an eye disorder caused by death of small groups of cells on the surface of the cornea (the clear layer in front of the iris and pupil). […] Doctors diagnose superficial punctate keratitis based on the person’s symptoms and the results of an eye examination. […] The diagnosis of superficial punctate keratitis is based on the symptoms, on whether the person has been exposed to any of the known causes, and on an examination of the cornea with a slit lamp (an instrument that enables a doctor to examine the eye under high magnification). During the examination, the doctor may apply eye drops that contain a yellow-green dye called fluorescein. The fluorescein temporarily stains damaged areas of the cornea, making it possible to see damaged areas that are not otherwise visible.

• #2 Keratitis: Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/keratitis

  Keratitis is an inflammation of the cornea. […] How is keratitis diagnosed? […] A thorough eye examination with a slit-lamp exam and potential use of fluorescein dye to enhance the visibility of corneal abnormalities. […] Laboratory analysis: Tears or corneal cells may be collected and sent to a lab for proper analysis. […] Like any eye condition, early treatment for keratitis is crucial. Contact your doctor for a proper diagnosis and prompt and accurate treatment if you experience eye pain with redness, swelling, difficulty opening the eye, or blurred vision.

• #2 Diagnosis And Management Of Nocardia Keratitis GlobalRPH

  https://globalrph.com/2021/01/diagnosis-and-management-of-nocardia-keratitis/

  Keratitis refers to infection of the cornea, the dome covering the eyes iris and pupil. […] The diagnosis of Nocardia keratitis is often missed or delayed due to the rarity and the clinical profiles resemblance to fungal keratitis. […] A comprehensive ocular examination is the first stage. This includes vision tests, ocular motility test, pupillary assessment, and recording intraocular pressure. […] History taking is the first step in making an Nocardia keratitis diagnosis. Ophthalmologists collect information on previous eye injury or surgery, and treatments used. […] The laboratory diagnosis starts with corneal scraping and/or biopsy where a Kimura spatula or a No.15 surgical blade is used to take samples from the cornea. […] The corneal scrapings are smeared, stained, and then examined under a confocal microscope.

• #2 Keratitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/561

  Keratitis is an ocular emergency and remains one of the major causes of blindness around the world. […] The diagnosis depends on a careful history, slit-lamp examination, and corneal scraping cultures. […] Key diagnostic factors include presence of risk factors, corneal infiltrate, corneal ulcer, dendritic or geographical epithelial lesion, periocular skin lesions, multifocal corneal ulcer with feathery edges, corneal perineuritis, and interstitial keratitis. […] Other diagnostic factors include redness, pain, increased lacrimation, lid oedema, discharge, decreased visual acuity, photophobia, high intraocular pressure, history of herpes simplex virus or varicella zoster virus infection, multiple old stromal scars, iris transillumination, and corneal hypoaesthesia. […] 1st investigations to order include corneal scraping: microscope slide and corneal scraping: cultures and sensitivity. […] Investigations to consider include FBC, HIV test, autoimmune testing, and corneal scraping: polymerase chain reaction (PCR) testing.

• #2 Fungal keratitis: Diagnosis, management and recent advances | OPTH

  https://www.dovepress.com/fungal-keratitis-diagnosis-management-and-recent-advances-peer-reviewed-fulltext-article-OPTH

  KOH at a concentration of 10-20% can be used to identify fungal growth with a direct microscope. […] For the diagnosis of fungal keratitis, the isolation of fungal elements by culture is considered the most sensitive method. […] Fungal keratitis definitive diagnosis is achieved if fungal elements are seen in corneal smears. […] Corneal biopsy with diagnostic keratectomy is more diagnostic than corneal scraping for fungal keratitis. […] In vivo confocal microscopy (IVCM) is an imaging technique that provides corneal tissue real-time imaging at the corneas microstructural level. […] Polymerase chain reaction (PCR) is considered a rapid and sensitive technique in the diagnosis of mycotic keratitis. […] Artificial intelligence (AI) is a promising technology that may play a great role in the diagnosis, follow-up, and management of all types of infectious keratitis.

• #2 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  However, negative cytology results do not exclude HSV infection. […] Viral cultures obtained within several days of onset of disease and prior to antiviral therapy have a sensitivity of up to 70% and also allow for identification of the HSV subtypes. […] Various techniques (eg, conventional tube culture, shell vial assay, suspension infection method) are available. […] HSV-antigen detection tests, such as the enzyme-linked virus-inducible system (ELVIS), are very specific for detecting herpes infection, but they are limited by their lower sensitivity. […] Cell culture for confirmation of HSV is recommended when the ELVIS test result is negative. […] PCR assay using tear samples, corneal epithelium, anterior chamber tap, or corneal buttons may detect viral DNA in cases of herpetic keratitis or keratouveitis.

• #2 Diagnosis of Acanthamoeba Keratitis: Past, Present and Future

  https://www.mdpi.com/2075-4418/13/16/2655

  Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. […] The diagnosis of AK can be challenging due to its initial non-specific presentation. It is typically unilateral, though it can be bilateral. Typical initial clinical features are pain, photophobia, watering and red eye, as well as epithelial irregularities, opacities, microerosions, microcystic oedema, and patchy stromal infiltrates. The degree of pain is classically described to be severe and disproportionate to the clinical picture. However, AK can also be painless, leading to diagnostic uncertainties.

• #2 Deep learning for multi-type infectious keratitis diagnosis: A nationwide, cross-sectional, multicenter study | npj Digital Medicine

  https://www.nature.com/articles/s41746-024-01174-w

  Given its reliable performance and the ability to swiftly provide classification results, DeepIK demonstrates a high potential to assist ophthalmologists in accurately and rapidly distinguishing among various types of IK. […] This system has the potential to aid ophthalmologists in accurately and promptly identifying the cause of IK, thereby improving patients visual prognosis through the initiation of targeted treatment at an early stage.

• #3 Keratitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/keratitis/symptoms-causes/syc-20374110

  Keratitis may or may not be associated with an infection. […] If you have eye redness or other symptoms of keratitis, make an appointment to see an eye specialist. […] Delays in diagnosis and treatment of keratitis can lead to serious complications, including blindness. […] If you notice any of the symptoms of keratitis, make an appointment to see an eye specialist right away. […] Keratitis is more common in people who use extended-wear contacts, or wear contacts continuously, than in those who use daily wear contacts and take them out at night. […] Use of corticosteroid eye drops to treat an eye disorder can increase your risk of developing infectious keratitis or make existing keratitis worse. […] Potential complications of keratitis include temporary or permanent reduction in your vision. […] Proper use, cleaning and disinfecting can help prevent keratitis. […] Follow your eye care provider’s recommendations for taking care of your lenses.

• #3 Herpes Simplex Keratitis – Eye Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/eye-disorders/corneal-disorders/herpes-simplex-keratitis

  Herpes simplex keratitis is an eye infection that involves the cornea (the clear layer in front of the iris and pupil) and is caused by herpes simplex virus. […] Doctors diagnose herpes simplex keratitis based on an examination of the person’s cornea and sometimes by swabbing the eye to identify the virus. […] To diagnose a herpes simplex infection, a doctor examines the eye with a slit lamp (an instrument that enables doctors to examine the eye under high magnification). During the examination, the doctor may put drops in the eyes that contain a yellow-green dye called fluorescein. The fluorescein dye temporarily stains the damage in the cornea a bright green, making it possible for the doctor to see a damaged area that is not otherwise visible. […] Sometimes, the doctor may swab the infected area to identify the virus, using either a viral culture or a nucleic acid amplification test (NAAT).

Zobacz więcej