Keratitis can be caused by an infection or injury to the eye. Keratitis is a common condition. In either case, you can take steps to help prevent this condition. If you do develop keratitis, see your doctor right away. Without treatment, keratitis symptoms will progress and get worse.
When symptoms appear can depend on the type of keratitis. For example, bacterial keratitis symptoms can appear right away. Learn more about eye care ». There are two main types of keratitis, depending on what causes it. Keratitis may be classified as either infectious or noninfectious.
Bacteria: Pseudomonas aeruginosa and Staphylococcus aureus are the two most common types of bacteria that cause bacterial keratitis. It mostly develops in people who use contacts improperly.
Fungi: Fungal keratitis is caused by Aspergillus, Candida, or Fusarium. As with bacterial keratitis, fungal keratitis is most likely to affect those who wear contact lenses. Parasites: An organism called Acanthamoeba has become more common in the United States in those wear contact lenses. The parasite lives outdoors and may be picked up by swimming in a lake, walking in a wooded area, or getting infected water on your contact lenses.
This type of infection is called Acanthamoeba keratitis. Viruses: Viral keratitis is primarily caused by the herpes simplex virus, which progresses from conjunctivitis to keratitis. Learn more about conjunctivitis ». Read more: Serious eye problems caused by misuse of contact lenses ».
Keratitis may be transmitted through an infection. This can happen if you come into contact with an infectious substance and then touch your eyes. It can also occur if you get sick and then the infection spreads to your eyes. In some cases, you can even transmit keratitis to yourself. For example, if you have an open sore from herpes, touching it before touching the eye area can lead to this condition.
These cases only become contagious if an infection develops. Any suspected symptoms of keratitis should be looked at right away. Subconjunctival hemorrhage is diagnosed clinically. It is harmless, with blood reabsorption over a few weeks, and no treatment is needed. Warm compresses and ophthalmic lubricants e.
If pain is present, a cause must be identified. It is good practice to check for corneal involvement or penetrating injury, and to consider urgent referral to ophthalmology. Recurrent hemorrhages may require a workup for bleeding disorders. If the patient is taking warfarin Coumadin , the International Normalized Ratio should be checked.
Episcleritis is a localized area of inflammation involving superficial layers of episclera. It is usually self-limiting lasting up to three weeks and is diagnosed clinically. Investigation of underlying causes is needed only for recurrent episodes and for symptoms suggestive of associated systemic diseases, such as rheumatoid arthritis. Treatment involves supportive care and use of artificial tears. Topical NSAIDs have not been shown to have significant benefit over placebo in the treatment of episcleritis.
Ophthalmology referral is required for recurrent episodes, an unclear diagnosis early scleritis , and worsening symptoms. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors. Petersen I, Hayward AC. Antibacterial prescribing in primary care. J Antimicrob Chemother.
Acute bacterial conjunctivitis. Acta Ophthalmol. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Leibowitz HM. The red eye. N Engl J Med. Galor A, Jeng BH. Red eye for the internist: when to treat, when to refer.
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Wagner RS, Aquino M. Pediatric ocular inflammation. Immunol Allergy Clin North Am. Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era. Pediatr Infect Dis J. Am Fam Physician. Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.
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Topical antibiotics for acute bacterial conjunctivitis: a systematic review. Acute bacterial conjunctivitis—benefits versus risks with antibiotic treatment. Increasing bacterial resistance in pediatric acute conjunctivitis. Antimicrob Agents Chemother. Emerging fluoroquinolone resistance in bacterial keratitis. Reattendance and complications in a randomised trial of prescribing strategies for sore throat. Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis J Antimicrob Chemother.
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Allergic conjunctivitis. Granet D. Allergic rhinoconjunctivitis and differential diagnosis of the red eye. Allergy Asthma Proc. Prevalance of dry eye syndrome among U. Jackson WB. Blepharitis: current strategies for diagnosis and management.
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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Jan 15, Issue. C 2 , 4 Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates. C 15 Anti-inflammatory agents e. C 32 Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline.
Algorithm for diagnosing the cause of red eye. Table 1. Figure 2. Figure 3. Management Options for Suspected Acute Bacterial Conjunctivitis Management option Patient group Consider immediate antibiotic therapy Health care workers Patients who are in a hospital or other health care facility Patients with risk factors, such as immune compromise, uncontrolled diabetes mellitus, contact lens use, dry eye, or recent ocular surgery Children going to schools or day care centers that require antibiotic therapy before returning Consider delaying antibiotic therapy Patients without risk factors who are well informed and have access to follow-up care Patients without risk factors who do not want immediate antibiotic therapy Information from references 2 and 9.
Table 2. Table 3. Injury: Scratches, scrapes and cuts to your cornea can cause noninfectious keratitis. These injuries can happen from a variety of sources, such as fingernail scratches, paper cuts, makeup brushes, tree branches, contact lenses, and chemical burns. The injury may also let in bacterial or fungus to cause an infectious keratitis.
Eyelid disorders that prevent proper eyelid function: If the eyelid does not close properly, the cornea can dry out, and keratitis can develop. Dry eye syndrome: The eyes are not able to leave a protective layer of tears called the tear film that washes, soothes and protects the eye every time you blink. The eye then becomes dry and irritated which can lead to keratitis. Exposure to intense ultraviolet UV light photokeratitis : Photokeratitis is caused by damage to the cornea by UV light.
The first sign and symptoms of keratitis is usually eye pain, redness, and blurred vision. Your eye may burn or feel irritated, or it may feel like you have something in it. Signs and symptoms of keratitis include:. Keratitis can cause permanent vision loss, so see your eye doctor right away if you have any of these symptoms.
If you wear contact lenses: Safe handling, storage and cleaning of your contact lenses are key steps to reduce your risk of keratitis. It is important to learn how to take care of your contact lenses. If you notice any of the signs or symptoms of keratitis, make an appointment to see your eye doctor right away.
If you wear contact lenses, do not wear them until you find out what is wrong. Bring your contact lenses and contact lens case with you to the eye exam. Delays in diagnosis and treatment of keratitis can lead to serious complications, including blindness. A very mild case of noninfectious keratitis will usually heal on its own. For mild cases, your eye doctor may recommend that you use artificial tear drops.
If your case is more severe and includes tearing and pain, you may need to use antibiotic eye drops to help with symptoms and prevent infection.
Your eye doctor may also prescribe steroid eye drops never with fungal keratitis after your infection has improved or is gone. These drops help to reduce swelling and help prevent scarring. You should only use steroid eye drops under close supervision by your eye doctor because steroid eye drops can sometimes make an infection worse. A corneal transplant replaces a damaged cornea with a healthy donor cornea.
You may require a corneal transplant if you have the following:. Keratitis, if caught early, is usually easy to treat and clears up quickly. Corneal scarring is the most common complication of keratitis, which can lead to vision loss. If keratitis is not treated in a timely manner, the infection could go through the cornea and spread to other areas of the eye leading to possible blindness.
It is important to see any eye doctor as soon as symptoms of keratitis are noticed. If you are sick, wash your hands often and try not to touch your eyes.
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