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