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  • AAO PPP Cornea/External Disease Committee, Hoskins Center for Quality Eye Care
    Cornea/External Disease
    Compendium Type: I

    By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Amy Lin, MD,1 Michelle K. Rhee, MD,2 Esen K. Akpek, MD,3 Guillermo Amescua, MD,4 Marjan Farid, MD,5 Francisco J. Garcia-Ferrer, MD,6 Divya Varu, MD7 David C. Musch, PhD, MPH,8 Steven P. Dunn, MD,9 Francis S. Mah, MD10

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

    1 John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
    2 Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
    3 The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
    4 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
    5 Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
    6 Mercy Clinic Eye Specialists, St. Louis, Missouri
    Dell Laser Consultants, Austin Texas
    Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
    Michigan Cornea Consultants, P.C., Southfield, Michigan
    10 Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California


    The majority of community-acquired cases of bacterial keratitis resolve with empiric therapy and are managed without smears or cultures. Smears and/or cultures are specifically indicated in the following circumstances: 1) a corneal infiltrate is central, large (>2 mm) and/or associated with significant stromal involvement or melting; 2) the infection is chronic in nature or unresponsive to broad-spectrum antibiotic therapy; 3) there is a history of corneal surgeries; 4) atypical clinical features are present that are suggestive of fungal, amoebic, or mycobacterial keratitis; or 5) infiltrates are in multiple locations on the cornea.

    Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients presenting with a contact lens-related corneal abrasion.

    Patching the eye in a patient who wears contact lenses and has a corneal abrasion is not advised because of the increased risk of bacterial keratitis. Bandage contact lens use in the management of these epithelial defects remains controversial.

    The use of a cycloplegic agent is an often-overlooked adjunctive treatment and may decrease pain as well as synechia formation in bacterial keratitis. It is indicated when substantial anterior chamber inflammation is present.

     Corticosteroids may be considered after 24 to 48 hours when the causative organism is identified and/or infection is responding to therapy. Corticosteroids should be avoided in cases of infection involving organisms like Acanthamoeba, Nocardia, and fungus.

    Awareness of the increased resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones is important.

    Literature Search

     Bacterial Keratitis PPP - 2018 - Literature Search.pdf