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Pseudomonas keratitis demonstrating stromal suppuration with surrounding corneal edema and anterior chamber hypopyon. Patient had a history of extended contact lens wear.

  • Commonly associated with soft as well as extended contact lens wear.
  • Among the most common causes of bacterial keratitis together with Staph. aureus, S. pneumonia and Moraxella sp.
  • Clinical features:
    • Symptoms may include:
      • Decreased vision
      • Photophobia
      • Pain
      • Red eye
      • Conjunctiva and/ or lid edema
      • Mucopurulent discharge
    • Signs:
      • Rapidly progressive ulceration with underlying dense suppurative stromal inflammation
      • Diffuse surrounding corneal edema
      • Thick mucopurulent, yellow-greenish exudates
      • Associated anterior chamber reaction and hypopyon formation
      • Risk of perforation
      • May have Wesley-like ring on endothelium
  • Management:
    • Cessation of contact lens wear.
    • Cycloplegia.
    • Topical antibiotics including tobramycin and/or fluoroquinolone.
    • Fortified antibiotics around the clock for sight threatening ulcers.
    • Consider subconjunctival antibiotics.
    • Systemic antibiotics for threatened perforation or scleral involvement.
    • Anticollagenase therapy (i.e. tetracycline family)

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