Pseudomonas Keratitis

• 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)