Pseudomonas Keratitis

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)